Preparations for irritable bowel syndrome
Irritable bowel syndrome( IBS) is a common disease that affects10-15% of the adult population. Its causes are unknown, and the symptoms can be very different and include abdominal pain, bloating and flatulence, constipation or diarrhea. Preparations from irritable bowel syndrome can not completely cure the patient, but they can significantly alleviate the symptoms.
In most cases, preparations for the treatment of irritable bowel syndrome are selected based on its clinical picture. The main condition for successful treatment of IBS is effective cooperation between the patient and the doctor, modification of the lifestyle and diet. Only in the absence of the effect of these measures the patient needs to start taking medications from irritable bowel syndrome.
Drug groups
Drugs used in IBS can be divided into the following groups:
- anticholinergics;
- anti-inflammatory drugs;
- antidepressants;
- laxatives, increasing the volume of stool;
- antagonists of serotonin receptors;
- activators of chloride channels;
- agonists of guanylate cyclase;
- probiotics.
The medicine for irritable bowel syndrome is selected based on the patient's existing clinical picture, that is, it is symptomatic.
The most common tools
Consider the indications for the drugs from the above groups.
Anticholinergics
Medications from this group have antispasmodic properties, that is, they suppress contractions of the smooth muscles of the intestine. These drugs help alleviate the symptoms of abdominal cramps in irritable bowel syndrome.
Dicyclomine( Bentyl)
This drug directly relaxes the smooth muscles of the intestine, without affecting the production of gastric acid. Its action begins 1-2 hours after taking and lasts up to 4 hours. Dicyclomine is taken orally, as a rule - 4 times a day before meals and at night.
To prevent the development of side effects, the doctor can first prescribe this remedy in small amounts, and then gradually increase the dose. Antacids reduce the absorption of dicyclomine, so it can not be taken simultaneously with it.
If you take this medicine for the treatment of irritable bowel syndrome regularly enough and for a long time, with a sudden discontinuation of its intake, withdrawal can occur, which is manifested by dizziness, sweating and vomiting.
Other side effects that may occur with the use of dicyclomine:
- dizziness( 40%);Dry mouth
- ( 33%);
- blurred vision( 27%);
- drowsiness( 9%);
- nervousness( 6%);
- general weakness( 7%).
Belly bloating, confusion, paralysis of accommodation, delirium, dermatitis, erythema, fatigue, hallucinations, insomnia, malaise, palpitations, rashes, syncopal conditions.
This preparation for the treatment of irritable bowel syndrome can not be used concomitantly with alcohol.
Dicyclomine is contraindicated in:
- allergies to it or other anticholinergic agents;
- closed angle glaucoma;
- myasthenia gravis;
- massive bleeding;
- intestinal atony;
- toxic megacolon;
- of intestinal obstruction;
- severe ulcerative colitis;
- reflux with esophagitis.
It is also not used in breastfeeding women and in children younger than 6 months.
With care, dicyclomine is prescribed :
- for patients with hepatic or renal insufficiency;
- for patients with benign prostatic hyperplasia;
- to people with congestive heart failure;
- for tachycardia due to heart failure or thyrotoxicosis, arterial hypertension, coronary heart disease, chronic obstructive pulmonary disease, mitral stenosis, brain damage;
- for tachyarrhythmias.
Hyoscyamine
This agent is used to treat problems with the digestive tract, including irritable bowel syndrome, as well as various diseases of the bladder. Hyoscyamine reduces the production of gastric acid, slows the peristalsis of the intestine, relaxes the smooth muscles in many organs.
Take this drug strictly as directed by your doctor. Rapid tablets are taken 30 to 60 minutes before meals orally or under the tongue at a dose of 125-250 μg every 4 hours or as needed. Do not exceed the dose of 1.5 mg per day( 12 tablets).
For prolonged-action tablets, 375-750 μg of hyoscyamine should be taken twice a day. Also you can not exceed the dose of 1.5 mg for 24 hours( 4 tablets prolonged action).
Side effects include:
- dry mouth;
- urinary retention;
- blurred vision;
- tachycardia;
- mydriasis;
- increased intraocular pressure;
- loss of taste perception;
- headaches;
- nervousness;
- drowsiness;
- weakness;
- nausea;
- vomiting;
- constipation;
- bloating and abdominal pain;
- diarrhea;
- allergic reactions, etc.
Admission of Hyoscyamine for the treatment of irritable bowel syndrome is contraindicated in patients with allergies to it, with closed angle glaucoma, myasthenia, urinary tract obstruction, digestive tract obstruction( eg stenosis of the pyloric), intestinal atony, unstable haemodynamics in bleeding, Severe ulcerative colitis.
The drug should not be used on women who breast-feed a child.
With caution, hyioscyamine is used in the presence of :
- for renal and hepatic insufficiency;
- congestive heart failure;
- ischemic heart disease;
- chronic obstructive pulmonary disease;
- diaphragmatic hernia;
- reflux esophagitis;
- of mitral stenosis;
- Down syndrome;
- autonomic neuropathy;
- hyperthyroidism;
- tachyarrhythmias.
Contraindications
Antiparasants for the treatment of irritable bowel syndrome slow down the passage of food and reduce the production of digestive juices.
Lomotil( diphenoxylate hydrochloride + atropine)
This combined formulation helps to reduce the frequency of bowel movements for diarrhea by slowing intestinal motility. Diphenoxylate is similar to narcotic analgesics, but mainly affects the intestines. Atropine belongs to the class of anticholinergic agents, which also slow the intestinal motility and reduce the secretion of digestive juices.
Adults with irritable bowel syndrome and diarrhea are first prescribed to take Lomotil 2 tablets 4 times a day, and then gradually reduce the dose individually. For children aged 2 to 13 years, Lomotil is administered as a syrup in a dose calculated for their weight. Most often, the relief of diarrhea occurs in the first 48 hours.
Side effects of this drug include:
- blurred vision;
- sedation;
- nausea and vomiting;
- discomfort and abdominal pain;
- dry mouth;
- exacerbation of pancreatitis;
- bloating;
- constipation;
- appetite impairment;
- drowsiness;
- heart palpitations;
- dyspnea;
- is nervousness and irritability.
Lamotil can not be administered to people with allergies to diphenoxylate or atropine, mechanical jaundice, intestinal obstruction, zakratougolnoy glaucoma, myasthenia, weakness of the muscular apparatus of the intestine, diarrhea associated with pseudomembranous colitis or bacterial infection.
It is used with caution in the presence of renal and hepatic insufficiency, ulcerative colitis.
Loperamide
This is one of the most commonly used antiparretic drugs for the treatment of irritable bowel syndrome. It slows down the peristalsis and reduces the wateriness of the stool, facilitating diarrhea.
For adult diarrhea, loperamide is given at the starting dose of 4 mg( 2 tablets) and then 2 mg( 1 tablet) after each liquid stool. Do not exceed the dose of 16 mg( 8 tablets) per day. In children aged 2 to 6 years, the use of Loperamide in the form of syrup is recommended, the dose is selected by the doctor on the basis of the severity of the disease and the weight of the child.
The drug is contraindicated in the presence of:
- allergies to loperamide;
- bloody diarrhea;
- very high body temperature;
- infectious diarrhea;
- pseudomembranous colitis;
- constipation.
Do not treat children under 2 years of age.
Adverse reactions to loperamide include:
- bloating;
- constipation;
- appetite impairment;
- nausea;
- dizziness;
- abdominal pain with nausea and vomiting;
- skin rash;
- drowsiness;
- dry mouth.
Antidepressants
Tricyclic antidepressants have an anti-depressant and analgesic effect in irritable bowel syndrome, therefore, effectively eliminate the symptoms of this disease.
Amitriptyline
This drug provides an analgesic effect in the intestines at doses that are lower than those needed for antidepressant action. Amitriptyline also lengthens the passage of food through the intestines, reduces abdominal pain and stool frequency, improves overall well-being. From irritable bowel syndrome, amitriptyline is taken in tablets at a dose of 10-50 mg once a day before bedtime.
This drug is contraindicated in the presence of an allergy to it, in the acute period of myocardial infarction, when treated with monoamine oxidase inhibitors for the previous 2 weeks, with glaucoma, at the age of 12 years.
Amitriptyline should be used with :
- for cardiovascular disease;
- diabetes mellitus;
- renal and hepatic insufficiency;
- thyroid dysfunction;
- convulsive seizures;
- benign prostatic hyperplasia;
- of urine retention;
- weakening of peristalsis.
The drug in the treatment of irritable bowel syndrome penetrates into the mother's milk, so at the time of its reception from breastfeeding must be abandoned. Amitriptyline side effects may include:
- constipation or diarrhea;
- nausea and vomiting;
- changes in appetite and weight;
- more frequent urination;
- rash, itching;
- swelling of the mammary glands;
- decreased sexual desire and impotence;
- dizziness;
- weakness;
- temperature increase.
In no event should you take Amitriptyline and alcohol at the same time.
Antibiotics
Antibacterial agents can be used in the treatment of irritable bowel syndrome to prevent excessive reproduction of intestinal bacteria.
Rifaximin
This is a semi-synthetic antibiotic that suppresses the synthesis of proteins in bacteria and their growth. Most often with IBS, Rifaximin is prescribed in the presence of diarrhea. As a rule, it is used in a dose of 550 mg every 8 hours for 14 days.
Rifaximin is contraindicated in the presence of an allergy to it. Side effects include flatulence, headaches, tenesmus, abdominal pain, nausea, constipation, fever, vomiting, allergic reactions, itching, rash.
Laxatives increasing the stool volume
These preparations consist of hydrophilic polysaccharides and mobile pulps that swell in intestinal fluid, forming a gel that facilitates the passage of intestinal contents and stimulates peristalsis. They can alleviate the symptoms of constipation and diarrhea.
Methylcellulose
This synthetic preparation is prescribed for irritable bowel syndrome for a mild laxative effect. Take it 2 capsules up to 6 times a day, be sure to wash down each dose with a glass of water.
Methylcellulose can not be used when:
- is allergic to it;
- of intestinal obstruction;
- symptoms of appendicitis or acute abdomen;
- the presence of ulcers in the digestive tract;
- is a foul smear;
- dysphagia;
- bleeding from the rectum.
Side effects of this drug include flatulence, excessive intestinal activity.
Plantain seeds
Preparations from plantain seeds stimulate the stool to form a gel-like liquid and promote peristalsis. They are available in the form of powder or granules, which are in bags. These drugs are taken in a dose of 2.5-7.5 grams, diluting in a glass of water, to reach 30 grams per day. Contraindications include allergies, intestinal obstruction, symptoms of appendicitis or an acute abdomen, the presence of ulcers in the digestive tract, fecal obstruction, dysphagia and rectal bleeding.
Side effects include abdominal cramps, flatulence, constipation.
Serotonin receptor antagonists
This group of drugs from irritable bowel syndrome uses Alosetron. The drug is used only in women with IBS, which manifests severe diarrhea and does not respond to standard treatment.
First appoint 0.5 mg orally every 12 hours for 4 weeks, then, subject to good tolerability, the dose is increased to 1 mg every 12 hours.
The drug is contraindicated in the presence of :
- allergies;
- rectal hemorrhage;
- constipation;
- ischemic colitis;
- intestinal obstruction;
- intestinal perforation;
- Crohn's disease;
- ulcerative colitis;
- severe hepatic impairment.
Side effects include :
- constipation;
- abdominal pain;
- nausea;
- headaches;
- fatigue;
- gastroenteritis;
- bowel straining;
- flatulence;
- hemorrhoids;
- urinary tract infection;
- ischemic colitis;
- concern;
- pain in the bones.
Chloride channel activators
Drugs increase the amount of fluid in the intestines, which stimulates its emptying. They are prescribed for IBS with constipation.
Lubiprostone
The drug is used for irritable bowel syndrome with constipation only in women over 18 years of age. Assign Lubiprostone at a dose of 8 μg orally every 8 hours.
It is contraindicated in case of allergy and mechanical intestinal obstruction. Side effects include nausea, vomiting, diarrhea, swelling, chest discomfort, fatigue, dizziness, flatulence, dyspepsia, dry mouth, abdominal pain.
Guanylate cyclase agonists
Drugs increase the secretion of fluid in the lumen of the intestine and accelerate the passage of food.
Linaclotide
Used to treat irritable bowel syndrome with constipation in adults, it helps increase the amount of intestinal contents by increasing fluid secretion. This facilitates the passage of contents through the intestines, and also reduces pain and discomfort in the abdomen.
Linaclectotide is taken at a dose of 290 μg once a day on an empty stomach 30 minutes before the first meal.
The drug is contraindicated in the presence of allergies to it, in children younger than 6 years of age, mechanical intestinal obstruction. In older children( 6 to 17 years) from using Linaclotype, one should also refrain, since there is insufficient information about its safety. Side effects include diarrhea, abdominal pain, flatulence, headaches, viral gastroenteritis, sinusitis, stool incontinence, fatigue, and vomiting.
Probiotics
These are products that contain so-called friendly bacteria, restoring the natural balance of the intestinal microflora. Some patients note that regular intake of probiotics helps to relieve symptoms of IBS, but these claims do not have scientific evidence.
If a person with irritable bowel syndrome has decided to take probiotics, he needs to be treated for at least 4 weeks.
Enterojermina
This preparation consists of a spore of the microorganism Bacillus clausii, which is a part of normal intestinal microflora, due to which it can be useful in its recovery. As a rule, Entererojermin is taken orally 1 bottle 2-3 times a day.
Contraindications include allergy to the drug, children under 1 month. In the treatment of Enterojermina, side effects rarely develop, possibly the occurrence of allergic reactions - hives and skin rashes.
Treatment with folk remedies and diet
Treatment of irritable bowel syndrome with medications is recommended to combine with therapy folk remedies and diet.
The diet is selected based on the prevailing symptoms. The patient needs to start a diary and mark in it the products consumed, record the symptoms of the disease. This will help to calculate that food, which provokes an exacerbation of IBS, to avoid it.
If IBS is combined with constipation, the increase in the amount of soluble fiber found in fruits, root vegetables( carrots, potatoes), oats, barley, rye can help. On the contrary, with diarrhea it is better to eat foods high in insoluble fiber - whole-grain foods, bran, nuts and seeds.
If the patient is worried about constant bloating, it can be helped by limiting the use of foods containing oligosaccharides, disaccharides, monosaccharides and polyols. These substances are quickly absorbed in the intestines, which is accompanied by the release of a large number of gases. Such products include ordinary, leaf, Chinese, colored and Brussels sprouts, broccoli, peas, chickpeas, lentils, and beans.
Often patients give priority to folk remedies against irritable bowel syndrome. You can do this, but first you need to consult a doctor, as some of the ingredients used in such treatment can interact with the medications that people take.
Like medical treatment, the use of traditional medicine in IBS depends on the symptoms of the disease:
- With frequent spasms in the abdomen helps infusion of peppermint. For its preparation 2 tablespoons of dry leaves pour a glass of boiling water and insist 20 minutes. Infusion can be used instead of tea.
- If the abdomen is swollen, infusion of dill can help. To make a tablespoon of herbs or fennel seeds, pour 500 ml of boiling water and insist for 2 hours. Eat 100-150 ml three times a day before meals.
- When diarrhea is sometimes used, infusion of pomegranate crusts. Spread a tablespoon of dried crust with 250 ml of boiling water and insist until pink. To consume follows at a time.
- With constipation, plantain seeds can help. To do this, 2 dessert spoons of seeds should be soaked in 100 ml of water for 30 minutes, after which they must be eaten.
In addition, patients with IBS are useful in physical exercises - they help alleviate depression and stress, stimulate the normal functioning of the digestive tract.
Irritable bowel syndrome is a common disease. This diagnosis is made if you can not find other causes of the existing symptoms of digestive disorders. Before starting to treat irritable bowel syndrome with medicines, you should try to eliminate its signs through diet and exercise.
Author: Taras Nevelichuk, doctor,
specially for Moizhivot.ru
