Listening to your irritable bowel syndrome patients with empathy and concern will go a long way toward helping them improve their health.
I’ve been thinking about irritable bowel syndrome (IBS) lately.
I believe it all started with the memorable advertisement for the drug Xifaxan by Valeant Pharmaceuticals. In the ads, an intestinal-shaped character dubbed “gut guy” urgently runs to the bathroom and then panics when he sees a long line. Some of your IBS patients can probably relate.
IBS treatments actually have a pretty interesting history. First, there were no specific treatments, and then new treatments were approved and either removed from the market or restricted. Alosetron (Lotronex) was approved in 2000 for IBS with diarrhea (IBS-D), voluntarily withdrawn from the market by the manufacturer, and then made available under a prescribing program. Tegaserod (Zelnorm) was approved in 2002 for IBS with constipation (IBS-C) and then later removed from the market. I can only imagine the frustration of an IBS patient at the time of this upheaval.
Today, we have a variety of FDA-approved treatments for IBS, both IBS-C and IBS-D (see table).
According to the 2014 American Gastroenterological Association Guideline on the Pharmacological Management of IBS, the suggested treatment options for IBS-C are linaclotide (Linzess), lubiprostone (Amitiza) and polyethylene glycol (PEG) laxatives. For IBS-D, the guideline suggested rifaximin (Xifaxan), Lotronex, loperamide, tricyclic antidepressants, selective serotonin reuptake inhibitors, and antispasmodics.
The 2014 American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation reviewed a variety of therapeutic options, both prescription and OTC.
This review found that the vast majority of treatment options are either ineffective or have insufficient evidence of efficacy. While many treatments are available, the only recommended therapies that had “strong evidence” of advantage over placebo of at least “moderate” quality of evidence are Linzess and Amitiza.
I hope that this review will assist you in your conversations with your patients. IBS can be an embarrassing, difficult-to-treat condition. Listening to your IBS patients with empathy and concern will go a long way toward helping them improve their health.
Lotronex is indicated only for women with severe diarrhea-predominant IBS who:
Severe IBS includes diarrhea and 1 or more of the following:
1. Ford AC, Moayyedi P, Lacy BE, et al. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol. 2014;109 Suppl 1:S2-26.
2. Weinberg DS, Smalley W, Heidelbaugh JJ, Sultan S. American Gastroenterological
Association Institute Guideline on the pharmacological management of irritable bowel
syndrome. Gastroenterology. 2014;147(5):1146-8.
3. Amitiza [package insert]. Deerfield, IL: Takeda Pharmaceuticals America, Inc.; April 2013.
4. Linzess [package insert]. Cincinnati, OH: Forest Pharmaceuticals, Inc.; November 2015.
5. Lotronex [package insert]. San Diego, CA: Prometheus Laboratories Inc.; August 2015.
6. Viberzi [package insert]. Parsippany, NJ: Actavis Pharma, Inc; May 2015.
7. Xifaxan [package insert]. Bridgewater, NJ: Salix Pharmaceuticals; November 2015.