IBS With Diarrhea: Prescription Options and the Gallbladder Warning to Know
Bloating & DigestionArticleFor IBS with diarrhea, a 2022 gastroenterology guideline gave conditional support to several prescriptions, including rifaximin, eluxadoline, alosetron, loperamide and low-dose tricyclic antidepressants, and advised against SSRIs. If you've had your gallbladder removed, one of those options is off the table.
In this article
Irritable bowel syndrome (IBS) is common and can weigh heavily on daily life.1 In the diarrhea-predominant type (IBS-D), urgency, loose stools and cramping dominate. Our guide to what IBS is covers diagnosis, and IBS with constipation covers the other main type.
What the 2022 guideline recommends
The American Gastroenterological Association reviewed seven medicine types and made eight recommendations, all conditional.1
| Recommendation | Medicines | Certainty |
|---|---|---|
| Suggested | Eluxadoline, rifaximin, alosetron | Moderate1 |
| Suggested | Tricyclic antidepressants, antispasmodics | Low1 |
| Suggested | Loperamide | Very low1 |
| Suggested against | SSRI antidepressants | Low1 |
Label warnings worth knowing
Eluxadoline: not for people without a gallbladder, because of a higher risk of serious pancreatitis or spasm of the bile-duct valve.2 It’s also off-limits with past pancreatitis, more than 3 alcoholic drinks a day, or a history of severe constipation.2 Our article on scans after gallbladder removal covers related symptoms.
Alosetron: approved only for women with severe IBS-D that hasn’t responded to usual treatment.3 It carries a boxed warning for ischemic colitis and serious constipation complications.3 Stop it and get checked right away for rectal bleeding, bloody diarrhea or new or worse belly pain.3
Before medicines: rule out look-alikes
Other conditions can cause similar diarrhea. See our guides to bile acid diarrhea tests and microscopic colitis.
Non-drug options with support for IBS overall include a short low-FODMAP trial, gut-directed hypnotherapy and peppermint oil.
Questions to ask
- Have other causes been ruled out, such as bile acid diarrhea, celiac disease or microscopic colitis?
- Which option fits me, given my gallbladder status and other conditions?
- What will it cost, and does my plan require trying cheaper options first?
Try: “I had my gallbladder out years ago and now have IBS with diarrhea. Which prescriptions are safe for me, and which should I avoid?”
Bloated by Dinner includes a Belly Clock log and a Test-It list with a visit script. Use them to track urgency, stool form and triggers before and after any new treatment. See the book.
This article is for general educational purposes only and is not medical advice. It isn't a substitute for diagnosis or treatment from a qualified healthcare professional who knows your health history. Please don't start or stop a prescription without talking to your clinician. New diarrhea after 50, blood in the stool, weight loss, anemia, fever, or diarrhea that wakes you at night needs evaluation, not just IBS treatment. If you think you may be having a medical emergency, call 911 or your local emergency number right away. This article discusses a clinical guideline and drug labels. Girl Playbook does not endorse any specific product, test, or provider.
Girl Playbook sells this book. It provides education and worksheets, not individualized medical care.
Sources
The research behind this article, in the order it’s cited. How we source our articles.
- Gastroenterology (abstract via PubMed), 2022AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Diarrhea (opens in a new tab)abcdef
- DailyMed, National Library of MedicineEluxadoline tablets: prescribing information (opens in a new tab)ab
- DailyMed, National Library of MedicineAlosetron tablets: prescribing information (opens in a new tab)abc
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