Approach to medical therapy for global IBS symptoms in adults

This algorithm summarizes a stepwise approach to pharmacotherapy for global symptoms (eg, abdominal pain, bloating, and cramping) in patients with IBS of any subtype. These are patients with persistent symptoms despite diet and lifestyle modifications and medical therapy based on IBS subtype or predominant bowel habit. Effective treatments are continued for the duration of benefit along with all effective subtype-directed therapy, diet, and lifestyle modifications. The exception is rifaximin, which is administered in a 14-day course. Please refer to related UpToDate content for additional detail.

FDA: US Food and Drug Administration; IBS: irritable bowel syndrome; NF: National Formulary; OTC: over-the-counter; USP: United States Pharmacopeia.

* In patients with both episodic and persistent global symptoms, episodic treatment may be combined with a TCA. Refer to inset for dosing and response interval.

¶ These medications may cause constipation. While this may be an added benefit in patients with diarrhea, they should be used with caution in patients with constipation.

Δ Antispasmodics are used as needed for short-term relief of abdominal pain and cramping episodes. Scheduled dosing for >2 weeks has not been studied. Available agents and formulations may vary depending on practice location.

◊ The doses listed are for commonly available OTC enteric-coated peppermint oil capsules. Capsules should be swallowed whole and taken before a meal. The FDA does not regulate peppermint oil capsules; dosing and composition can vary among products. Independently certified products (eg, USP, NF) are preferred. Refer to the package label before use.

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Approach to medical therapy for global IBS symptoms in adults