Tag Archives: Imodium

MedShadow’s Top 10 Stories of 2018

What were the most popular stories we published in 2018? Our Top 10 includes two stories on drugs that have become popular among opioid abusers, as well as articles dealing with drug interactions, a controversial class of antibiotics and a first-person story on an herbal supplement that has come under attack from the FDA, among others. Here are excerpts of the stories with the highest readership.

1. Gabapentin’s Secret: The Drug Opioid Abuser’s Crave

By Ronni Gordon

For many people who take gabapentin – a drug prescribed to treat seizures and pain caused by shingles – side effects such as sedation can be a challenge, as those who take it off-label for neuropathic pain told MedShadow in the past.

But an increasing number of opioid abusers crave that side effect, reporting a calm feeling when combining gabapentin – developed by Pfizer under the brand name Neurontin – with opioids, muscle relaxants and anxiety medications. Some also get a marijuana-like high and an enhanced euphoria. But when overused or abused, it can cause significant organ or brain damage. Read more →

2. Managing Eczema: Are New Treatments Like Eucrisa Worth It?

By Madeline Vann

Eczema (atopic dermatitis) can feel like a moving target for people who live with it. They get control over one flare, only to have eczema redden and irritate another patch of skin. For some patients, changing their bathing and beauty habits along with a thick moisturizer and topical corticosteroid ointments are enough.

“Steroids are the mainstay of treating atopic dermatitis. They’ve been around for decades. They are generally inexpensive, and for the vast majority of patients, that’s how we start treatment,” explains dermatologist Amy Paller, MD, director of the Northwestern University Skin Disease Research Center in Chicago. American Academy of Dermatology (AAD) guidelines recommend using emollient moisturizers, lifestyle changes to avoid triggers, and corticosteroids at first. Read more →

3. How Imodium Became Appealing to Opioid Addicts

By Padma Nagappan

A sports injury from playing squash in high school lead to a herniated disc for Bob Johnson (name changed to protect his privacy), who was initially given codeine for his pain, and then bumped up to hydrocodone, which is more powerful and used to treat severe pain.

He stopped taking the drugs once he began recovering. All was well until he left for college in Philadelphia and started playing on the squash team — and his back began hurting again. He found it was easy to get access to drugs and began buying OxyContin (oxycodone) from a dealer. Read more → 

4. What is the Best Way to Treat Heat Rash?

By Dave Walker, RPh

Question: It’s summer and I’m going to be spending a lot of times outdoors. I’m susceptible to heat rash. What is the best treatment for it?

I remember anticipating summer vacation as a kid. We were always busy planning and participating in neighborhood sporting activities, biking, hiking, fishing and camping trips. The neighborhood moms always had a ready supply of Band-Aids, Bactine and antiseptic cream to take care of those expected and inevitable scratches, scrapes, cuts and insect bites along the way. Read more →

5. 4 Drugs That Interact with Anxiety Meds

By Christy Huff, MD

If you suffer from anxiety, panic disorder or insomnia, your doctor may have prescribed you a tranquilizer belonging to a class of drugs known as benzodiazepines.

Drugs such as Xanax (alprazolam), Valium (diazepam), Ativan (lorazepam), and Klonopin (clonazepam) are some of the most-prescribed medicines – more than 133.4 million such prescriptions were filled in the US in 2014. As with any medication, drug interactions can occur if you take a benzo with another medication, and in certain cases, may be life-threatening. Read more → 

6. Why Aren’t Seniors Getting the Shingles Vaccine?

By Rita Colorito

Nearly 12 years after the FDA approved Zostavax, the first vaccine to prevent shingles in adults 60 and older, the vast majority of seniors still haven’t received it. Only 30.6% of adults age 60 and older reported getting the shingles vaccine, according to the latest CDC (Centers for Disease Control and Prevention) assessment of vaccine coverage.

Since it became available, Zostavax has faced numerous barriers in terms of getting seniors vaccinated, the assessment found. In October, the FDA approved a new shingles vaccine, Shingrix, for people age 50 and older. Less than a week later, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended Shingrix as the CDC’s preferred shingles vaccine for adults age 50 plus due to Shingrix’s better efficacy and fewer side effects compared to Zostavax. Read more → 

7. Floxed! The Painful, Life-Lasting Effects of Some Antibiotics

By Suzanne B. Robotti

Last week, we ran a news story on antibiotics causing “rare” damages to people. We had a very passionate response from more than 75 people who all claimed to be harmed by a particular type of antibiotics. More than 60,000 people have complained to the FDA about them. It begs the question, how unusual are these “rare” harms.

The side effects and adverse events associated with Cipro, Levaquin and other fluoroquinolones (FQs) can be significant and life altering. Yet many people who have been damaged by fluoroquinolones complain that there are too few warnings. Many claim that doctors don’t believe that their new illnesses have come from the FQs. Worse, sometimes FQs are prescribed when other, less risky — and just as effective — antibiotics are available. Read more →

8. The FDA Has It Wrong on Kratom: How the Herb is Helping People Like Me

By Andrew Turner

Some may ask who are the consumers of kratom, an herb used to treat pain, depression and anxiety that has been the subject of controversy lately in the news. It’s complicated.

We can be anyone. We are your neighbor, the veteran in the supermarket, your college professor and even your best friend. There’s a lot of misconceptions about kratom, how it’s used to treat certain ailments and its potential for addiction. Read more →

9. Can An Opioid Addiction Drug Treat Autoimmune Disorders

By Deborah Lynn Blumberg

A slew of drugs, both new and old, are used to treat autoimmune disorders like multiple sclerosis (MS), lupus and Crohn’s disease. Most of them come with side effects, some of them serious. But research and experience from patients and doctors are mounting that a drug used to treat substance abuse, when used in lower doses, can effectively treat autoimmune conditions with few side effects.

The drug is naltrexone, which was first approved in the 1980s to treat heroin addiction. In recent years, it has been prescribed more and more at a low dose for patients with autoimmune disorders. But is this off-label use (yet to be approved by the FDA) safe and effective? Read more →

10. Pros and Cons: Prednisone

By Tori Rodriguez

If you visit the doctor from time to time for anything other than a routine checkup, it’s likely that at some point you’ve received a prescription for a type of drug called corticosteroids. These are among the most commonly prescribed medications in the US, and they are used in almost every medical specialty.

In a study published last year, researchers at the University of Michigan found that 1 in 5 American adults with commercial health insurance had been prescribed a corticosteroid at least once over a 3-year period. Read more →

How Imodium Became Appealing to Opioid Addicts

A sports injury from playing squash in high school lead to a herniated disc for Bob Johnson (name changed to protect his privacy), who was initially given codeine for his pain, and then bumped up to hydrocodone, which is more powerful and used to treat severe pain.

He stopped taking the drugs once he began recovering. All was well until he left for college in Philadelphia and started playing on the squash team — and his back began hurting again. He found it was easy to get access to drugs and began buying OxyContin (oxycodone) from a dealer.

“I had a lapse of judgment,” he admitted. “The OxyContin was really expensive, and one time the dealer gave me a small bag of heroin, and that’s how I got started. It was cheaper, so I started using it twice a week, then it very quickly became every day.”

He got kicked off the squash team, and continued to use heroin on and off for a year, before switching to fentanyl. He began supplementing with Imodium (loperamide), an anti-diarrhea drug, to cope with withdrawal symptoms when he could not get heroin or fentanyl.

How Addicts Substitute Anti-Diarrhea Drug as an Opioid

Imodium is a widely available, over-the-counter medicine to treat diarrhea, and is meant to be taken as a 4 mg dose the first time (2 capsules), and thereafter in 2 mg doses (1 capsule), for teens and adults, and at half those levels for children under 12 years. To get a high or to cope with withdrawal symptoms, it needs to be taken in very large amounts, in the range of 50 to 100 2 mg capsules.

Imodium is a actually an opioid and is 40 to 50 times more potent than morphine in the gut, according to the May edition of QuarterWatch report from the Institute for Safe Medication Practices. But since absorption from the gut is poor, very little of the drug permeates the blood-brain barrier at normal doses, which is why it takes large amounts to induce a high.

At such large levels, can possibly cause life-threatening or fatal cardiac events and seizures, and as more people with substance abuse issues have figured out they can use it as a stopgap, more adverse events have appeared on the radar of medical providers, alerting them to this fairly new trend for drug abuse.

In Johnson’s case, he began using loperamide after discovering its effects accidentally. About to leave on a long flight, he picked up a packet of Imodium from a pharmacy in the airport so he wouldn’t have to keep going to the restroom on the plane. He was also experiencing withdrawal, and when he took a lot of the anti-diarrhea pills, he found it helped with withdrawal symptoms.

“I did experience heart palpitations, but I continued using large doses while I was withdrawing, not so much to get high on it,” he said.

“Many drug users are very smart,” said Carla Marienfeld, MD, an addiction psychiatrist with the University of California, San Diego School of Medicine. “People figured out that if they took loperamide in high amounts, or in combination with medicines that alter the stomach’s [acidity], it can be absorbed more systemically across the barriers and act on opioid receptors.”

Serious Side Effects

The adverse effects from loperamide depend on how much someone takes, and what other drugs they are on, Marienfeld noted. If it’s combined with tuberculosis or cardiac medications, it can trigger arrhythmia (irregular heartbeat) or worsen the risk of arrhythmias.

Certain psychiatric medications, when combined with it, can also prolong the interval in the heart’s electric cycle of waves. If the intervals get longer, it can cause tachycardia (when your heart rate exceeds the normal resting rate), which, if left untreated, can lead to heart failure, stroke or cardiac arrest, so such patients will need periodic electrocardiograms to measure it.

“Some people are biologically predisposed; they have a congenital predisposition to certain types of arrhythmias that can be worsened with loperamide abuse,” she said. “If people are taking it to get high, oftentimes they’re combining it with other drugs to get better gut absorption. These medications can also increase the cardiac risk.”

On the lower end of side effects, loperamide can cause palpitations, as it did in Johnson’s case. It can also cause all the typical effects of an opioid, such as constipation, sweating, euphoria, dizziness, nausea, vomiting and lower blood pressure.

“When people are trying prevent withdrawal, which is a miserable feeling, they get severe diarrhea, muscle and joint pain, nausea, they vomit, they have hot and cold flashes,” Marienfeld explained. “So they’ll take whatever is available to prevent this very miserable state, including loperamide.”

FDA Red Flags

Adverse effects from loperamide overdoses have been reported to the FDA’s Adverse Event Reporting System (FAERS) database over the 39 years that it has been available to the public. But it didn’t trigger a red flag until recently because only 48 cases of serious or fatal events were reported over that time, a small number compared to the many thousands of fatal events that the FAERS logs each quarter, the ISMP report observed.

Poison control centers reported that overdoses doubled between 2009 and 2015. By 2014, there were reports in medical literature about near-fatal incidents from overdoses.

In 2016, the FDA realized there was an emerging problem with loperamide abuse leading to fatal events, and issued a warning. It followed it up with an updated warning this year, reporting that it was working with drug manufacturers to develop abuse-resistant packaging that contains fewer doses.

In May, FDA Commissioner Scott Gottlieb wrote a blog post about the increasing abuse of loperamide, and how he is working with manufacturers to transition to blister packaging, to post warnings about risks on their website and packaging, and to reduce the number of pills available in one package. Loperamide is approved to be sold in packages containing 8 to 200 tablets, which are often sold in multipacks of 1,000 pills at a time, representing more than 3 years’ supply of pills.

However, exactly how many overdoses happen is still not known, since reporting is voluntary and there is no effective system in place to assess potential harm, which the ISMP’s report notes. Whether this is a rare but novel form of abuse or a substantial safety issue cannot be determined because of limitations with the entire post-market surveillance system, ISMP said in its report. Better and more comprehensive systems are needed to assess emerging drug risks, estimate incidence and support methods to reduce them.

Fatal events can occur if there is a big change in the dosage and frequency, and seizures can happen if a patient stops taking it abruptly.

Should Loperamide Be Behind the Counter?

“I don’t know if that is warranted, but having some data will help decide if it’s worth considering moving it behind the counter,” Marienfeld said. “I don’t think we have enough data to decide if we need a large public health intervention.”

However, she added, “A better public health intervention would be to limit how many pills of it could be sold, such as 16 pills, as opposed to allowing 200 of them to be sold. That makes more sense.”

Quick Hits: Imodium Abuse, Polypharmacy and Hospitalization & More

The FDA is requesting that the over-the-counter anti-diarrhea medicine Imodium (loperamide) be packaged differently to prevent abuse. There have been numerous reports indicating that people have intentionally misused and abused high doses of the treatment as a substitute for opioid drugs. In some cases, this has led to serious heart problems and death. In order to rectify this problem, the agency sent a letter to manufacturers asking that they limit the amount of drug per package for short-term use. For instance, a package could contain 8 2-milligram capsules, which would be enough for about 2 days. Posted January 30, 2018. Via FDA.

Taking 5 or more drugs increases hospitalization risk among older adults both with and without HIV. Yale researchers collected data from the Veterans Aging Cohort Study and analyzed adults with and without HIV who received at least 1 medication in 2009. The research team analyzed the patients, who were around 50 years old, over the course of 6 years. The results of the study indicated that older people — both with and without HIV — who took multiple drugs simultaneously had a greater risk of being hospitalized or dying. Posted January 30, 2018. Via AIDS.

The boxed warning on 2 classes of asthma medications has been removed. The warning on long-acting beta-agonists (LABAs) and inhaled corticosteroids (ICS) that cautioned consumers about asthma-related death was removed after the FDA reviewed 4 large clinical trials and found that treating asthma with LABAs in combination with ICS does not cause more serious asthma-related side effects (such as hospitalization, the need for a breathing tube, or asthma-related deaths) than treatment with ICS alone. Posted December 20, 2017. Via FDA.

Got IBS? Try Dietary, Lifestyle Modifications Before Drugs

You have a recurring pain in your abdomen, and it’s usually accompanied by diarrhea or constipation. Could it be indigestion from a spicy meal last night, or something more serious? For millions of Americans – and many more who go undiagnosed – it’s the latter, and it’s likely a condition known as irritable bowel syndrome (IBS).

If you’ve been diagnosed with IBS – and 15 million Americans have – you may be familiar with some of the newer drugs used for this condition, such as Linzess (linaclotide) and Viberzi (eluxadoline). After all, they have been heavily advertised. But are medications the best way to treat the condition? And what side effects or other risks are associated with these and other drugs used to treat IBS?

For starters, let’s talk about what IBS is: a disorder marked by abnormal activity in the gastrointestinal tract without any evidence of damage or disease. IBS most commonly affects individuals younger than 45 years and occurs twice as often in women compared to men.

“IBS symptoms include abdominal pain with either diarrhea or constipation,” says Edward M. Brettholz, MD, AGAF, FACP, a clinical assistant professor of medicine at the NYU School of Medicine, and a partner physician at Concorde Medical Group in New York City. Some patients have “mixed IBS,” which involves both constipation and diarrhea at different times. IBS symptoms vary from person to person and they often come and go without warning.

Try Dietary and Lifestyle Changes

Many people with IBS achieve relief with medication, though at the risk of side effects. However, most of the drugs deal with symptoms of IBS rather than addressing the root of the problem. Dietary changes could help you achieve long-lasting relief from IBS, and minimize the use of medication. In fact, the FDA recently announced that its researchers are exploring new IBS treatment options, including the potential role of dietary modification.

The first step is to avoid certain foods and drinks that may be contributing to your gut discomfort. Alcohol, chocolate, caffeinated drinks, dairy products and artificial sweeteners can aggravate your gastrointestinal system. And if you find your IBS is accompanied by gas or bloating, you may want to try cutting down on beans, cabbage and broccoli, and stop drinking carbonated beverages.

Increasing fiber in your diet may also provide help in some people. Try experimenting with increasing your intake of whole grains, some fruits and vegetables and beans. But go easy, since too much fiber can actually worsen symptoms. Make sure you drink enough water to prevent dehydration, which can lead to constipation. Boosting intake of probiotics, the good bacteria found in some types of yogurt, has also shown some benefit. But research has shown some probiotics work better than others.

A study found that exercising several times per week significantly improved IBS symptoms in patients and without side effects seen with medications. Exercise also reduces stress, which can cause IBS.

Not only does exercise relieve stress – one of the potential causes of IBS – it may also help to quell IBS symptoms as it stimulates normal contractions in your intestines. A 2011 study even found that people with IBS who engaged in physical activity several times a week saw their symptoms improve much more compared to those who didn’t exercise. There is also some evidence that yoga can play a role in minimizing IBS.

You might also want to seek some alternative medicine approaches. For example, some small studies have shown acupuncture can relieve some IBS symptoms, such as bloating. Certain herbs, such as peppermint, and an herb blend known as STW 5 (Iberogast) may provide relief in some patients. However, reviews of herbal remedies for IBS treatment have come up with mixed results in terms of efficacy.

The Lowdown on IBS Medication

If you find dietary and lifestyle changes don’t provide enough relief, there is a wide range of over-the-counter and prescription drugs available to treat IBS symptoms and to prevent the condition from becoming worse. Still, side effects can occur with any of these medications.

“The variations in symptoms and the patient’s unique response to effective therapies make the side effects even more challenging,” but they “are usually minor if patients communicate with their physician sooner than later,” explains Norman P. Tomaka, BSPharm, MS, FAPhA, a clinical consultant pharmacist in Melbourne, Fla., and media liaison for the American Pharmacists Association.

We asked Tomaka and Dr. Brettholz for the scoop on side effects that may arise from the use of different IBS drugs. Here’s what we learned:

  • Antispasmodics like Bentyl (dicyclomine), Librax (chlordiazepoxide /clidinium) and Levsin (hyoscyamine) can cause drowsiness, difficulty urinating, blurry vision and dryness of the mouth, nose and eyes. These may also cause a rapid heart rate in some patients. Lowering the dose often eases these symptoms.
  • Antidiarrheals such as Imodium (loperamide) and Lomotil (diphenoxylate/atropine) can cause dizziness and drowsiness, and constipation may result from higher and more frequent doses. These drugs should only be used occasionally, and only as needed.
  • Antibiotics like Xifaxan (rifaximin), which is used to treat travelers’ diarrhea but is also approved for IBS with diarrhea, can cause nausea, fatigue and dizziness, and some patients experience swelling in the abdomen and extremities. Because it is poorly absorbed by the gastrointestinal tract, however, side effects are not common, and resolution of symptoms can last several months. For IBS, Xifaxan is to be taken for only 14 days, though the treatment course can be repeated up to 2 more times if symptoms recur.
  • Probiotics to treat and prevent diarrhea can cause bloating and gas. Depending on whether the probiotic comes from fungus or bacteria, patients with weakened immune systems can develop infections from overgrowth of the probiotic in rare cases. However, compared to medications, the side effect profile of probiotics is very favorable and can be used long term.
  • Injectable biologics like Entyvio (vedolizumab), Humira (adalimumab) and Remicade (infliximab) are indicated for chronic inflammatory diseases of the intestines, such as Crohn’s disease and colitis, but have been used off-label for IBS. However, they have been associated with pain at the site of injection, as well as headache, skeletal and muscle discomfort and infections – mostly of the upper respiratory system.
  • Bile acid sequestrants such as Questran (cholestyramine) can reduce the absorption of other medications if taken at the same time or within 1 to 2 hours of each other. In addition, some patients experience abdominal pain and gas.
  • Dietary fiber supplements like Konsyl and Metamucil (psyllium) can cause cramping and constipation and, in rare cases, intestinal obstruction can occur if patients are not drinking enough clear liquids. Citrucel (methylcellulose) may cause less bloating.
  • Laxatives to relieve constipation can cause diarrhea and electrolyte abnormalities, but typically only if they are overused.
  • Gastrointestinal agents including Amitiza (lubiprostone) and Linzess act on intestinal fluid and food movement through the gut. These medications can cause significant changes in bowel movements, ranging from diarrhea to constipation, and some patients may experience abdominal pain, gas and nausea. Diarrhea may be reduced by reducing the dosage, and taking the medication with food can help ease nausea.

The newer gastrointestinal agent Viberzi can cause nausea and constipation, which may improve by switching to a lower dose. In rare cases, there have been reports of pancreatitis in patients taking Viberzi who had previously had their gallbladder removed. Because Amitiza, Linzess and Viberzi are among the newest IBS medications, the long-term impact of using these drugs is largely unknown.

  • Antidepressants such as Effexor (venlafaxine), Lexapro (escitalopram) and Wellbutrin (bupropion) can be used to treat IBS symptoms such as pain and bloating when given in much smaller doses than when prescribed for depression or anxiety. Still, they can cause insomnia or drowsiness, agitation, headache and nausea, and some patients may experience rapid heart rate. Tricyclic antidepressants like Elavil (amitriptyline), Pamelor (nortriptyline) and desipramine can cause weight gain, drowsiness and reduced blood pressure when standing up quickly. Some patients also experience heart palpitations with these drugs. Many patients with IBS use antidepressants for only 6 months to a year and they are meant for people with more severe forms of the condition.

“Of course, these medications should only be used under the supervision of a physician, and they should be notified of any side effects” as soon as they occur, Dr. Brettholz advises. Tomaka adds that patients should generally communicate with their healthcare provider more frequently in the period of time just after starting on a new IBS treatment.

“The best way patients can minimize troublesome side effects from IBS treatments is through communication,” he notes. “If side effects do occur, communication with the physician soon after is more likely to prevent more serious events from occurring.”

What Is Irritable Bowel Syndrome and How Best to Treat It?

Irritable bowel syndrome (IBS) is a real pain. You can have difficulty going to the toilet, which gives you a buildup of pain and discomfort in your gut. Or, you need to stay close to the toilet because you can’t contain your bowels when you get the urge.

Either way, it’s an incredibly unpleasant situation.

Ten to 15% of adults and an estimated 6% to 14% of children suffer from IBS. The symptoms can severely impact quality of life, so much so that the condition has been linked to suicidal behavior. That’s why it’s important to know that IBS is considered a real medical condition. And just as crucial, there is help out there for you.

Numerous medications are used to treat the unpleasant condition, but all have side effects you should be aware of. They can be as minor as dizziness and drowsiness, or as severe as muscle cramps, tremor and weight gain. You can find out more below about IBS and the best ways to treat it.

What is IBS?

IBS is termed a “functional gastrointestinal (GI) disorder.” This means that compared to average, the GI tract of people with IBS works more slowly, quickly or differently.

What causes IBS?

The cause is often due to many reasons and can be the result of GI hypersensitivity, small intestinal bacterial growth, psychosocial factors, increased intestinal inflammation and dysregulated communication between the gut and the brain.

What are the symptoms of IBS?

Symptoms include abdominal pain and discomfort, bloating, constipation, diarrhea or both, along with altered bowel function such as frequency, incomplete evacuation, and frequent changes hard/loose stool alteration.

What are the treatment options for IBS?

“I treat a lot of IBS sufferers, and it’s an illness that is quite difficult to treat,” says Jordan Tishler a Harvard-trained physician who focuses on holistic care. Generally, Dr. Tishler recommends a variety of approaches including medications, diet and alternative treatments. “They seem to work additively, [with] some approaches working better for some people than for others.”

Additional fiber is frequently recommended for IBS patients. Though, while “bulk-forming laxatives, like Metamucil, can be quite helpful, even for diarrhea-predominant IBS, they can also provoke gas and bloating,” notes Dr. Tishler.

Registered dietitian Ryan Whitcomb suggests that some individuals may experience additional relief with “galactooligosaccharide (GOS), a prebiotic that may improve stool consistency, flatulence, bloating and overall IBS symptoms.” It is available as a dietary supplement.

Common Medications Used to Treat IBS and their Side Effects

In terms of side effects, “all medicines have them, they come with the territory. However, we must remember that most people do NOT get side effects, or at least not badly enough to stop using the medication,” says Dr. Tishler. “That said, medications need to be viewed as a risk/benefit situation, and trying them with your eyes open and taking stock of their benefit after a while is the best plan.”

NameBrandsTypeOTC/RXSide effects
HyoscyamineLevsin, Levbid and 25 other brand namesAntispasmodicRXDry mouth, dizziness, blurred vision, nausea, drowsiness, weakness, and nervousness.
DicyclomineBentyl, TriacetinAntispasmodicRX
LoperamideImodium, Pepto Diarrhea Control, DiamodeAntidiarrhealOTCDry mouth, dizziness and drowsiness.
Diphenoxylate/ AtropineLomotil, Lonox, Vi-Atro, LomocotAntidiarrhealRXBlurred vision, confusion, difficult urination, dry mouth, fever, headache and potentially addictive. Side effects after ceasing meds – sweating, muscle cramps, nausea, trembling and stomach cramps.
Amitriptyline/ desipramineVanatrip, Elavil, Endep / NorpraminTricyclic antidepressantsRXTachycardia, dizziness, nervousness, sedation, tremor and weight gain.
DuloxetineCymbaltaSSRI antidepressantRXInsomnia, dizziness, weakness, drowsiness, diarrhea, constipation, headache.
XifaxanRifaximinAntibioticRXFlatulence, headache, nausea, abdominal pain, bowel urgency.

Newer medications, such as Lotronex (alosetron), Viberzi (eluxadoline), Amitiza (lubiprostone) and Linzess (Linaclotide), have been approved specifically to treat IBS or relate symptoms, but they also have side effects to be aware of. Lotronex has a “black box” warning about the risk of serious gastrointestinal adverse reactions, including colitis and severe complications from constipation. Use of Viberzi can lead to pancreatitis and a muscle spasm in the digestive system.  Amitiza can cause nausea, diarrhea and abdominal pain. And Linzess should be not be taken by those under 18.

Dietary Options

Anti-Inflammatory Diet

“Food is a big IBS trigger, and it’s vital to address diet,” says Whitcomb. “When food is the cause of the symptoms, nothing will relieve the symptoms until the foods are identified and subsequently removed.”

Whitcomb suggests that removing inflammatory foods resolves most, if not all, IBS-related symptoms within a matter of weeks. “I use the MRT [mediator release testing] blood test which looks at 120 foods and 30 food chemicals and reports which foods the patient’s immune system is overreacting to, causing inflammation, pain and digestive issues,” he says. “Once we identify these foods, we remove them from the diet and add in the foods we know they are not reactive to.”


FODMAPs refer to a group of carbohydrates that may trigger IBS symptoms due to poor absorption in the small intestine, which then leads to increased fermentation in the GI tract. Therefore, eliminating FODMAP foods provides relief.

The low FODMAP diet has been shown to be effective in reducing symptoms in 70%-86% of participants in scientific studies.

Alternative Treatments


Probiotics (Bifidobacterium infantis 35624 and Lactobacillus plantarum 299V) help manipulate the types of bacteria in the gut, which subsequently relieves pain, discomfort, bloating and constipation. Probiotics (Bifidobacterium infantis M-63, breve M-16V and longum BB536) are particularly beneficial in children where other forms of treatment have no benefit. If you want to get more probiotics in your diet naturally, seek out yogurt.

Herbal Medicine

Peppermint oil in capsule form taken 3 times a day 15-30 minutes before meals may help  improve abdominal discomfort, bloating and overall symptoms. However, it can cause heartburn in some people.

Ginger and ginger extract may help reduce nausea, decrease inflammation, strengthen the gut lining and stimulate bowel function.

St. John’s wort may help relieve stress-related symptoms associated with IBS.

Homeopathic remedies

The only homeopathic remedy with some evidence) of benefits is asafoetida, an herb with a pungent smell.


Dr. Tishler, an expert on cannabis therapeutics, suggests the only therapy he has found to be highly effective is marijuana.

“Cannabis used once daily at bedtime can control symptoms without the side effects produced by laxatives or antidiarrheal medication like Imodium,” he says. “Of course, cannabis has some side effects as well, like intoxication or dry mouth. Though, with care, these side effects can be managed and IBS patients do very well.”

Quick Hits: Warnings on 2 OTC Drugs, Yes to Experimental Cancer Drugs, & More

Despite warning labels, the FDA is receiving reports about bleeding associated with over-the-counter (OTC) antacids that contain aspirin. The medications, which are sold under well-known brand names such as Alka-Seltzer, Medique Medi Seltzer and Bromo Seltzer, are used to treat heartburn, sour stomach, acid indigestion, or upset stomach. The FDA warns that consumers may have a higher risk of serious bleeding when taking the aspirin-containing antacid products if they have one or more risk factors such as being 60 years or older, have a history of stomach ulcers or bleeding problems, take a blood thinner or steroid medication, drink alcohol or take pain medications known as NSAIDs (non-steroidal anti-inflammatory drugs). Posted June 6, 2016. Via FDA.

The OTC anti-diarrhea medication Imodium can lead to serious heart problems that can be fatal if abused, the FDA is warning. Combining a higher dosage of loperamide with other medications, as well as intentionally abusing and misusing the drug can trigger life-threatening side effects, such as abnormal heart rhythms. Most of the reported heart problems were found in people who were deliberately taking higher doses of Imodium. and consciously misusing the drug in order to achieve a feeling of euphoria. Posted June 6, 2016. Via FDA.

The FDA has made it easier for patients with life-threatening illnesses to receive experimental drugs more quickly. The release form for the agency’s “compassionate use” policy on experimental drugs initially consisted of 26 questions. Now it is down to 11 questions, and should now take physicians only 45 minutes to complete. The formatting of the application has been redesigned from an all-purpose format that aimed to evaluate a large group of patients to a simpler version that aligns with individual patients. Doctors may have initially been deterred from applying for the compassionate access policy due to its complicated nature, according to an FDA spokeswoman. Posted June 8, 2016. Via Kaiser Health News.

Many patients are continuing to take powerful opioid painkillers (such as OxyContin, Vicodin and Percocet) months after joint replacement surgery. With opioid overdoses in the United States increasing at a rapidly fast rate, the findings are significant because joint replacement surgery is becoming increasingly common. A new study examined 574 patients undergoing knee or hip replacement surgery. Before their surgery, approximately 30% of those patients were taking opioid painkillers. Despite improvements in their knee and hip pain, 53% of knee patients and 35% of hip patients were still taking painkillers 6 months after their surgery. Posted June 3, 2016. Via HealthDay.

A patch to treat migraines may leave some people at risk of serious burns or permanent scars. The FDA said it has received reports of reporting from users who experienced burns or scars on the skin where the Zecurity (sumatriptan) patch was applied. Some descriptions included in the reports were, “severe redness, pain, skin discoloration, blistering, and cracked skin.” While the FDA investigates this safety issue further, they encourage users to remove the Zecurity patch immediately if they are experiencing side effects and contact their health professional. Posted June 2, 2016. Via FDA.

Quick Hits: Skin Reaction Concern With Antipsychotic, & More

The antipsychotic Zyprexa (olanzapine) can cause a rare but serious skin reaction that can progress to other parts of the body, according to a drug safety communication from the FDA. The agency is adding a new warning to the labeling for all olanzapine-containing products that describes this severe condition known as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). A search of the FDA Adverse Event Reporting System database identified 23 cases of DRESS reported with Zyprexa worldwide since 1996, when olanzapine was first approved. Posted May 10, 2016. Via FDA.

People on the blood clot-preventing drug warfarin showed a higher dementia risk if their blood levels of the medication were frequently too high or too low, according to researchers at the Intermountain Medical Center in Utah. The findings are based on records from over 10,000 patients who were on warfarin for atrial fibrillation or to prevent blood clots from other causes. Over 6 to 8 years, almost 6% of the atrial fib patients developed dementia, including Alzheimer’s disease — versus less than 2% of other warfarin patients. Posted May 5, 2016. Via HealthDay News.

Some people addicted to oxycodone and other opioids are turning to over-the-counter diarrhea medications to manage their withdrawal symptoms or get high. Researchers at SUNY Upstate Medical University describe two case studies where people who were addicted to opioids tried to ease their withdrawal symptoms by taking many times the recommended dose of loperamide (sold under the brand name Imodium), a drug used to treat diarrhea. Both patients died. “Because of its low cost, ease of accessibility and legal status, it’s a drug that is very, very ripe for abuse,” said lead author William Eggleston, PharmD, a fellow in clinical toxicology at the Upstate New York Poison Center. Posted May 3, 2016. Via NPR.

Taking cholesterol-lowering statins right before heart surgery has no benefit and may even cause harm, a new University of Oxford study suggests. Crestor (rosuvastatin) did not prevent either the abnormal heart rhythm known as atrial fibrillation or heart damage, and it was linked to a slightly increased risk of kidney damage, researchers said. The percentages of those who developed atrial fibrillation were essentially the same in patients given Crestor (21.1%) and those given a placebo (20.5%), the investigators found. Posted May 4, 2016. Via HealthDay News.

If the 21st Century Cures Act “is not carefully crafted, it could pose a significant risk” for the agency and patients too because it could cause drugs and devices to be approved too quickly, FDA Commissioner Robert Califf said. The goal of the legislation, which passed last year, is to speed the approval of innovative drugs and medical devices. Califf told attendees at the Food and Drug Law Institute Annual Conference that the FDA’s “fundamental challenge” is how to provide guidance and oversight that promotes innovation, while also ensuring product safety. Posted May 6, 2016. Via Bloomberg BNA.