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C/D and IBS-C/IBS-D

GenericBrandClass/IndicationMOADoseCI/WarningsADRsOther Info
Psyllium/ Polycarbophil Metamucil/ Fibercon Bulk-forming agent Increase stool water content, increase rate of stool transit N/A Separate from other drugs by 1-2 hours Bloating, flatulence, obstruction (take lots of water) Relief w/in 3 days; preferred in elderly and pregnancy
Docusate Colace Emollient Adds to stool moisture making it softer 100 mg PO BID CI <2 yo cramping, diarrhea, nausea Relief w/in 3 days; "mush"
Mineral Oil --- Emollient Lubricates stool Adults: 30-45 mL PO daily 6-12: 5-15 mL PO daily Can be given PR Avoid long term use cramping diarrhea, nausea, aspiration Relief in 6-8 hours; don't take while laying down
PEG Miralax, GoLytely Osmotic laxative Increased water retention increasing frequency 17 g (capful) PO daily (w/water) 170 g if used for prep DNU >1-2 weeks flatulence, cramping, diarrhea Relief w/in 3 days; can be used for prep
Lactitol Pizensy Osmotic laxative Causes water influx into small intestine N/A CI in galactosemia; separate by 2 hours flatulence, cramping, diarrhea Relief w/in 3 days
Lactulose Constulose Osmotic laxative Increases water retention, increases colonic peristalsis, and increases frequency N/A --- Electrolyte imbalance Relief in 1-6 hours; use in cirrhotic patients
Saline Fleet Osmotic laxative N/A Relief in 1-6 hours
Bisacodyl Dulcolax Stimulant laxative Stims enteric nervous system increasing fluid/electrolyte secretion 5-15 mg PO QD or 10 mg PR Antacids cause early release; decreases efficacy; not preferred in peds cramping, electrolyte imbalances, malabsorption Relief in 8-12 hours; "push"
Senna Senokot, Ex-lax Stimulant laxative Stims enteric nervous system increasing fluid/electrolyte secretion 17.2 mg PO QD not preferred in peds cramping, electrolyte imbalances, malabsorption Relief in 8-12 hours; "push"
Naloxegol Movantik PAMORA (mu receptor antag.) Peripheral μ Opioid receptor antagonist 25 mg PO qd es; half-dose if abd pain or CrCl <60 CI in obstruction and hepatic impairment; DDI w/ 3A4 abd pain, flatulence, nausea, dizziness, GI perforation Take on empty stomach
Naldemedine Symprioc PAMORA (mu receptor antag.) Peripheral μ Opioid receptor antagonist 0.2 mg PO qd w/ or w/o meals CI in obstruction and hepatic impairment abd pain, flatulence, nausea, dizziness, GI perforation can be taken w/o regards to meals
Methylnaltrexone Relistor PAMORA (mu receptor antag.) Peripheral μ Opioid receptor antagonist Weight-based SQ dosing QOD or SQ/PO QD PO w/ water and es 30 minutes before 1st meal CI in obstruction; hepatic dosing abd pain, flatulence, nausea, dizziness, GI perforation PO taken on empty stomach
Loperamide Imodium Antimotility agent Stims μ opioid receptor in intestines Adults: 4 mg then 2 mg after each stool MAX 16 mg Peds: 2 mg then 1 mg MAX 6 mg for 9-11 yo; 4 mg for 6-8 yo
Diphenoxylate-Atropine Lomotil Antimotility agent Stims μ opioid receptor in intestines + atropine to discourage abuse Adults: 5mg-0.05mg QID until improvement MAX 20mg-0.2mg x 10 days Peds 2-12: Liquid only; 0.3-0.4 mg/kg/day divided into 4 doses MAX 10mg-0.1 mg/day
Bismuth subsalicylate Pepto-Bismol Antisecretory agent Antisecretory and direct antimicrobial against bacteria and viruses 524 mg q30-60 minutes for 48 hours (MAX 4800 mg/day)
Probiotics, Digestive enzymes, Adsorbents Probiotic 10, Lactaid, Fibercon Misc. agent Pro: suppress pathogenic flora Lactaid aids digestion Adsorbents adsorb Adsorbent Polycarbophil 1250 mg QID
Octreotide Sandostatin PGE analog SST analog inhibiting intestinal secretion and stimulates intestinal absorption N/A
Cholestyramine, Colestipol, Colesevelam Meh... Bile acid sequestrant Decrease bile acids N/A
Linaclotide Linzess Prokinetic; Guanylate cyclase-C agonist/ IBS-C increases intestinal fluid secretion and decreases transit time 290 mcg PO daily 30 minutes before first meal CI in peds, obstruction, dehydration Diarrhea; BBW: dehydration of peds High evidence level, take on empty stomach 30 minutes before meal
Plecanatide Trulance Prokinetic; Guanylate cyclase-C agonist/ IBS -C increases intestinal fluid secretion and decreases transit time 3 mg PO daily CI in peds <12 BBW: dehydration in peds ---
Tenapanor Ibsrela NHE3 inhibitor/ IBS-C Inhibits Na/H exchanger isoform 3 50 mg PO BID immediately before breakfast and dinner
Lubiprostone Amitiza CIC-2 Cl channel activator/ IBS-C Chloride channel activator; increases intestinal fluid secretion; aiding transit 8 mcg PO BID cf and water for adult female 8 mcg PO QD initially for hepatic impairment CI in obstruction, severe diarrhea nausea from gastric emptying Women only, movement expected w/in 24 hours
Eluxadoline Viberzi μ/k opioid receptor agonist/ IBS-D decreases pain and diarrhea 100 mg PO BID cf
Rifaximin Xifaxin Non-absorbable abx/ IBS-D Abx against gram +/- 550 mg TID x 2 weeks; may repeat up to 2 times
Alosteron Lotronex 5-HT3 antagonist/ IBS-D Selective 5-HT3 antagonist N/A CI in hepatic impairment Constipation, ischemic colitis
Dicyclomine Bentyl Antispasmodic/ Adjunctive IBS Reduce smooth muscle contraction QID, D/c after 2 weeks Drowsiness, dizziness, blurred vision
Hyoscyamine Levsin Antispasmodic/ Adjunctive IBS Reduce smooth muscle contraction 30-60 minutes before meals Drowsiness, dizziness, blurred vision
Created by: aarel01
 

 



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