Luminary Learning Gastrointestinal Disorder- Issue 1

24  • LUMINARY LEARNING: GASTROINTESTINAL DISORDERS The recommended dose of lubiprostone is 8 µg twice daily; however, this dose might be increased if the symptoms do not improve [70]. Of note, some of the patients experience signifi- cant relief in all symptoms only after 1 month of the treatment what has to be taken into con- sideration by specialists planning therapy. Lubiprostone is contraindicated in patients exhibiting chronic diarrhea, bowel obstruction, or IBS-D and is not approved for the use in children. Box 1. Anti-IBS drugs in the nutshell. Drug Key information IBS-D Alosetron • 5-HT 3  receptor antagonist is effective for the treatment of IBS-D in women • Indications include: (i) chronic IBS symptoms (generally lasting 6 months or longer), (ii) the absence of anatomic or biochemical abnormalities of the GI tract, (iii) disability or restriction of daily activities due to IBS and (iv) no adequate response to conventional therapy Ramosetron • Licensed for use only in Japan and selected Southeast Asian countries (e.g. India) Loperamide • At high doses loperamide may induce constipation • Treatment starts with a relatively low dose (approx. 2 mg) and then it is titrated up or down based on the symptoms Trimebutine • Indications include: (i) IBS, (ii) abdominal pain and abdominal cramping and (iii) dyspepsia • May be administered in multiple doses per day with the maximal total daily dose of 600 mg Eluxadoline • Contraindications to the treatment include: (i) biliary duct obstruction, or sphincter of Oddi disease or dysfunction, (ii) alcohol abuse or addiction, or patients who drink more than three alcoholic beverages per day, (iii) a history of pancreatitis or structural diseases of the pancreas, including known or suspected pancreatic duct obstruction, (iv) a history of chronic or severe constipation or known or suspected mechanical gastrointestinal obstruction Rifaximin • Recommended is a 14 day therapy with the dose of 550 mg (orally), three times a day • Therapy may be repeated for another 14 days • The most common adverse events are headache, upper respiratory infection, nausea, nasopharyngitis, diarrhea and abdominal pain IBS-C Polyethylene glycol 3350+ electrolytes • Well tolerable and effective treatment that should be considered suitable for use as a first-line treatment in functional GI disorders manifested by chronic constipation Tegaserod • Long-term safety of tegaserod was investigated in a prospective study suggesting that treatment was safe over a 12-month period • Not approved for use in the EU due to the opinion that its benefits do not outweigh its risks Prucalopride • The most frequently reported adverse events include headache, abdominal pain, nausea and diarrhea • Approved in Europe for both men and women; however, it has not been allowed for sale in the USA Lubiprostone • Recommended dose is 8 µg twice daily; however, this dose might be increased if the symptoms do not improve • Contraindicated in patients exhibiting chronic diarrhea, bowel obstruction, or IBS-D and is not approved for the use in children