1. Jackie Skradski Pharm.D. Candidate 2016 Ferris State University College of Pharmacy February 25, 2015

2.  By the end of the presentation, the audience should be able to: Recommend non-pharmacological therapies to patients suffering from IBS Recognize side effects of specific pharmacological treatments

3.  Chronic functional syndrome of the GI tract involving: Bloating, abdominal pain, altered bowel habits  3 predominant types: Diarrhea (IBS-D) Constipation (IBS-C) Mixed (IBS-M) Image by Gut Health. Available from: http://www.guthealth.info/irritable-bowel-syndrome-16/ Chang L, Lembo A, Sultan, S. American gastroenterological association institute technical review on the pharmacological management of irritable bowel syndrome. Gastroenterology. 2014;147:1149-1172.

4.  Non-pharmacological  IBS-C  IBS-D  Pain/cramping

5. Type of DiseaseRecommendation Any type  Stress Reduction  Probiotics  Dietary modification  Avoid triggers  Psychotherapy Constipation  High fiber diet  Increase fluid intake Diarrhea  Lactose-free diet  Caffeine-free diet  Avoid alcohol  Avoid artificial sweeteners (sorbitol, fructose, mannitol)  High fiber diet Fabel PH, Shealy KM. Chapter 23 diarrhea, constipation, and irritable bowel syndrome. In: Dipiro JT, Talbert RL, Yee GC, et al, editors. Pharmacotherapy: a pathophysiologic approach [Internet]. New York (NY): McGraw-Hill; c2008 [cited 2015 Feb 17]. [about 30 screens]. Available from: http://0- accesspharmacy.mhmedical.com.libcat.ferris.edu/content.aspx?bookid=689&sectionid=45310478 Chang L, Lembo A, Sultan, S. American gastroenterological association institute technical review on the pharmacological management of irritable bowel syndrome. Gastroenterology. 2014;147:1149-1172.

6. DrugRecommendationSide EffectsDose/Administration/Cauti ons Linaclotide (Linzess®) High  Diarrhea  Flatulence  Dose: 290 mcg daily  Admin: 30 minutes before first meal, swallow whole  Caution: Adult use only Lubiprostone (Amitiza®) Moderate  Diarrhea  Nausea  Headache  Dose: 8 mcg twice daily  Admin: With food and water, swallow whole  Caution: Approved for adult women PEG Laxative Low  Minor diarrhea  Nausea, vomiting  Flatulence  Cramping  Dose: 17 grams daily  Admin: Dissolve in 8 ounces of water  Caution: Only used as adjunct Fabel PH, Shealy KM. Chapter 23 diarrhea, constipation, and irritable bowel syndrome. In: Dipiro JT, Talbert RL, Yee GC, et al, editors. Pharmacotherapy: a pathophysiologic approach [Internet]. New York (NY): McGraw-Hill; c2008 [cited 2015 Feb 17]. [about 30 screens]. Available from: http://0- accesspharmacy.mhmedical.com.libcat.ferris.edu/content.aspx?bookid=689&sectionid=45310478 Chang L, Lembo A, Sultan, S. American gastroenterological association institute technical review on the pharmacological management of irritable bowel syndrome. Gastroenterology. 2014;147:1149-1172.

7. DrugRecommendationSide EffectsDose/Administration/Cautio ns Rifaximin (Xifaxan®)Moderate  Well tolerated  Dose: 550 mg three times daily for 14 days  Admin: With or without food  Caution: May need repeated treatments Alosetron (Lotronex®)Moderate  Ischemic colitis  Severe constipation  Dose: 0.5-1 mg twice daily  Admin: With or without food  Caution: Women only & REMS required Loperamide (Imodium®) Very low  Constipation  Dose: 2-8 mg daily  Admin: With or without food  Caution: Only used as adjunct Fabel PH, Shealy KM. Chapter 23 diarrhea, constipation, and irritable bowel syndrome. In: Dipiro JT, Talbert RL, Yee GC, et al, editors. Pharmacotherapy: a pathophysiologic approach [Internet]. New York (NY): McGraw-Hill; c2008 [cited 2015 Feb 17]. [about 30 screens]. Available from: http://0-accesspharmacy.mhmedical.com.libcat.ferris.edu/content.aspx?bookid=689&sectionid=45310478 Chang L, Lembo A, Sultan, S. American gastroenterological association institute technical review on the pharmacological management of irritable bowel syndrome. Gastroenterology. 2014;147:1149- 1172.

8. DrugRecommendationSide EffectsCautions TCAs (Amitriptyline, Desipramine, Imipramine, Trimipramine, Doxepin) Low  Anticholinergic  Sedation  Caution: With use in IBS-C  Caution: Avoid if risk of prolonged QT-interval SSRIs (Fluoxetine, Paroxetine, Citalopram) Low (AGAINST use)  Sexual dysfunction  Nausea, vomiting, diarrhea  Caution: With use in IBS-D Antispasmodics (Hyoscyamine, Dicyclomine, Peppermint oil) Low  Dry mouth  Dizziness  Blurred vision  Caution: With use in IBS-C Fabel PH, Shealy KM. Chapter 23 diarrhea, constipation, and irritable bowel syndrome. In: Dipiro JT, Talbert RL, Yee GC, et al, editors. Pharmacotherapy: a pathophysiologic approach [Internet]. New York (NY): McGraw-Hill; c2008 [cited 2015 Feb 17]. [about 30 screens]. Available from: http://0-accesspharmacy.mhmedical.com.libcat.ferris.edu/content.aspx?bookid=689&sectionid=45310478 Chang L, Lembo A, Sultan, S. American gastroenterological association institute technical review on the pharmacological management of irritable bowel syndrome. Gastroenterology. 2014;147:1149- 1172. Weinberg DS, Smalley W, Heidelbaugh JJ, Sultan S. American gastroenterological association institute guideline on the pharmacological management of irritable bowel syndrome. Gastroenterology. 2014;147:1146-1148.

9.  Did not compare efficacy of one medication to another medication  Only compared to placebo  There is a gap in knowledge on IBS-M Chang L, Lembo A, Sultan, S. American gastroenterological association institute technical review on the pharmacological management of irritable bowel syndrome. Gastroenterology. 2014;147:1149-1172.