Irritable Bowel Syndrome

Table 6. Treatment Options for IBS-C (continued) Drug (Brand) Recommended Dose Comments Stimulant laxatives (continued) Diphenylmethane derivatives Bisacodyl (Dulcolax® Correctol® ) Stool soſtener Docusate sodium (Colace® ) Phosphate enema (Fleet® Tap-water enema Glycerin bisacodyl suppository Prokinetic agents 5-HT4 Cisapride (Propulsid® Tegaserod (Zelnorm® -receptor agonists )a )a , Surfak® , Regulax SS® , Rectal enemas or suppositories Enema) 120 mL daily 500 mL daily 10 mg daily 5-10 mg every night Hydrolyzed by endogenous esterases; stimulates secretion and motility of small intestine and colon 100 mg bid Ionic detergents soſten stool by allowing water to interact more effectively with solid stool; modest fluid secretion; efficacy for treatment is not well established Initiates evacuation by distending the rectum, soſtening hard stool, and topically stimulating the colonic muscle to contract; hyperphosphatemia and other electrolyte abnormalities can occur if the enema is retained 10-20 mg qid 6 mg bid (1A female ≥ 18) Stimulation of 5-HT4 intestines induces peristalsis; cisapride, a substituted benzamide, had variable results in treating constipation; potentially lethal cardiac dysrhythmias led to its removal from the commercial market; tegaserod, a partial 5-HT4 receptors in the an aminoguanidine indole derivative of serotonin that reduces pain and bloating, increases the frequency of bowel movements, and improves their consistency in women with IBS-C agonist, is Chloride channel activator ) Lubiprostone (Amitiza® 8 mcg PO bid with meals (1B female ≥ 18) Lubiprostone acts by specifically activating ClC-2, enhancing a chloride-rich intestinal fluid secretion without altering sodium and potassium concentrations in the serum. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. a Removed from the market in the U.S. through a restricted program. Adapted from Lembo A, Camilleri M. Chronic constipation. N Engl J Med. 2003;349(14):1360-1368.

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