Alosetron Lotronex11 5HT4 Raptor Agonist

Tegaserod maleate (Zelnorm)^

In IBS With Diarrhea:

$0-t50 mg po daily 10-t 50 mg po daily

In IBS With Constipation:

10-10 mg po daily

Trig po: then 2 mg po after each loose stool: daily maximum 16 mg

1 mg po daily

6 mg po twice daily

^Withdrawn from general use; available only under special circumstances.

Bulk Producers

Bulk producers may improve stool passage in IBS-C but are unlikely to have a fa-

vorable effect on pain or global IBS symptoms. Psyllium may increase flatulence, which may worsen discomfort in some patients. Methylcellulose products are less likely to increase gas production. Although fiber-based supplements are more likely to be useful in IBS-C, these products may be dose-adjusted in diarrhea to increase stool consistency. Other laxative products might be used in IBS-C, but most are less desirable than bulking agents due to the potential for unwanted effects.

Antimotility Agents

Loperamide stimulates enteric nervous system receptors, inhibiting peristalsis and flu-

id secretion. It improves stool consistency and reduces the number of stools. Consequently, it is most useful in patients who have diarrhea as a prominent symptom. However, it can occasionally aggravate abdominal pain.


Stimulation of 5-HT3 receptors triggers hypersensitivity and hyperactivity of the large intestine. Alosetron (Lotronex) is a selective 5-HT3 antagonist that blocks these receptors and is used to treat women with severe IBS-D. Eligible patients should have frequent and severe abdominal pain, frequent bowel urgency or incontinence, and restricted daily activities. Alosetron has been shown to improve overall symptoms and quality of life. Alosetron can cause constipation in some patients.

Because alosetron has been associated with ischemic colitis, it may be prescribed only under strict guidelines, including signing of a consent form by both patient and physician. Patients selected for therapy should exhibit severe chronic IBS symptoms and should have failed to respond to conventional therapy.

Tegaserod Maleate

Tegaserod maleate (Zelnorm) stimulates 5-HT4 receptors in the GI tract, thereby increasing intestinal secretion, peristalsis, and small bowel transit. It also reduces sensitivity related to abdominal distention. It has been shown to be more effective than

placebo in improving global IBS symptoms and altered bowel habits in IBS-C. However, because a higher risk of heart attack, stroke, and unstable angina (heart/ chest pain) in patients treated with tegaserod maleate is suspected, the drug has been withdrawn from general use. The FDA can authorize use of tegaserod maleate for emergency situations only. The FDA must also authorize the drug to be shipped.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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