| PAIN |
|---|
|
Anti-spasmodics
|
Hyoscine, otilonium, pinaverium, cimetropium |
Inhibition of muscarinic Ach receptors, or block Ca++ channels, GI smooth muscle |
May be effective; OR 0.68 (0.57 to 0,71) Overall NNT 5; NNT for: hyoscine 3.5, otilonium 4.5, cimetropium 3, pinaverium 3 |
| Peppermint Oil |
block L-type Ca++ channels on muscle, activate TRPM8 receptors on nociceptive afferents |
Effective: OR: 0.43 (0.32 to 0.59); Global: RR 2.23 (1.78 to 2.81) Overall NNT 2.5; RCT of sustained release formulation: ↓ pain, bloat, urgency but not total IBS scores |
|
Anti depressants
|
slow (TCA) or fast (SSRI, SNRI) transit |
Psychological, antinociceptive effects |
Effective OR: 0.67 (0.58 to 0.77) for global; OR 0.62 (0.43 to 0.88) for abdo. pain; NNT 4 |
| DIARRHEA |
|---|
|
Opioid agents
|
Loperamide |
μ-opioid agonist inhibits secretion, transit |
Unknown for IBS; effective for diarrhea |
| Eluxadoline |
κ-, and μ-opioid receptor agonist and δ-opioid receptor antagonist |
Effective for FDA composite endpoint; 100mg: OR 0.87 (0.83 to 0.91); 75mg: 0.89 (0.84 to 0.94); RCTs: Effective for diarrhea and composite diarrhea + pain; not for pain alone |
|
5-HT3 receptor antagonists
|
Ondansetron Alosetron Ramosetron |
Retard colonic transit and reduce visceral pain |
Effective: Global RR 1.60 (1.49 to 1.72); Pain RR 1.30 (1.22 to 1.39); FDA composite: OR 0.69 (0.60 to 0.80) RCTs: Class effective for all symptoms: diarrhea; composite diarrhea + pain; and pain alone. Ondansetron efficacy for diarrhea, urgency, bloating, not for pain |
|
Bile acid sequestrants
|
Cholestyramine Colestipol Colesevelam |
Bind intraluminal bile acids |
Unknown; Effective in open label studies; ineffective in one, single center RCT |
|
Antibiotic
|
Rifaximin |
Non-absorbable antibiotic |
Effective: In 2012 SRMA: Global: OR 1.57 (1.22 to 2.01); Bloating: OR 1.55 (1.23 to 1.96); In 2020 SRMA: FDA composite: OR: 0.92 (0.86 to 0.98) Global OR: 0.91 (0.77, 1.07) |
| CONSTIPATION |
|---|
|
Osmotic
|
PEG3350 |
Osmotic secretion |
Effective: improves SBMs, CSBMs, consistency straining but not pain, bloating or incomplete evacuation |
|
Secretory
|
Lubiprostone |
Chloride channel (C1C2) activation and CFTR stimulate Cl” secretion |
Effective: Lubiprostone 8μg RR: 0.85 (0.78 to 0.96) for FDA endpoint |
| Linaclotide |
Guanylate cyclase C activator, stimulate Cl− and water secretion via CFTR; visceral analgesia |
Effective: Adequate relief IBS: RR 1.95 (1.3 to 2.9); Abdo pain: RR 1.58 (1.02 to 2.46) RR 0.81 (0·76 to 0·86) for 290μg for FDA endpoint |
| Plecanatide |
Effective: Using FDA- endpoint 6mg: RR 0.87 (0·81 to 0·94); 3mg RR 0.88 (0·82 to 0·94) |
|
Anti-absorptive
|
Tenapanor |
NHE3 inhibitor stimulates Na+, water secretion |
Effective at 50mg b.i.d. dose; RR 0.85 (0.79 to 0.82) for FDA endpoint; NNTs for CSBM and combined CSBM + >30% pain reduction: 7-9; NNT for abdo. pain reduction >30% alone: 11 |
| 5-HT4 receptor agonists |
Tegaserod |
Stimulate colonic motility and transit |
Effective: tegaserod 6mg b.i.d. showed RR, 0.85 (0.80—0.91) for FDA endpoint |
