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14 Best IBS Medication Over The Counter

14-Best-IBS-Medication-Over-The-Counter

Irritable bowel syndrome (IBS) is a common condition that is characterized by smooth muscle spasms alongside the gastrointestinal tract with a range of associated symptoms. Patients who are diagnosed with IBS are usually advised on lifestyles to minimize the risk of IBS symptoms. A review of diet and lifestyle is one of the first recommendations given by a doctor once a patient is diagnosed with IBS.

Drug treatment can be used alongside lifestyle measures. Most of the drugs which are recommended in the symptomatic management of IBS can be purchased over the counter from pharmacies, supermarkets, and online. Today I will review the 14 best IBS medications over the counter.

This review will look at the availability of IBS medication over the counter and compare it with the recommended guidelines on IBS treatment. In summary, the following IBS medication over the counter will be reviewed:

  • IBS drugs for the treatment of constipation
  • IBS drugs for the treatment of diarrhea
  • IBS drugs for the management of cramps and spasm
  • IBS pain management with over the counter drugs
  • Other over the counter drugs used for IBS

Firstly, let’s review the NICE guidelines on IBS management (NICE, 2017).

Constipation

National guideline on the management of IBS broadly divides the treatment into two categories:

  • Dietary and lifestyle advice.
  • Pharmacological (drug) therapy.

IBS: Dietary And Lifestyle Advice

Patients diagnosed with IBS are usually advised on self-help related to lifestyle, physical activity, and diet. General recommendations include (ibid):

  • Having regular meals
  • Drinking plenty of fluids throughout the day, preferably water, and drinks without caffeine
  • Limit alcohol intake
  • Limit tea and coffee consumption
  • Reduce high-fiber foods. Fiber requirements should be reviewed regularly, depending on the symptoms present.
  • Limit intake of processed food, which contain difficult to digest starch
  • People who experience episodes of diarrhoea should avoid artificial sweeteners, which can cause a laxative effect. Sorbitol, a common sweetener, can be found in sugar-free versions of drinks, sweets, and chewing gums
  • Aloe vera should not be used to treat IBS

IBS: Drug Therapy

IBS medications are used for symptomatic management of the condition. National guidelines suggest the use of different drugs, depending on the patient’s symptoms. Drugs used in the management of IBS can be divided into the following categories:

Laxatives: for the treatment of constipation (lactulose should be avoided). Most laxatives, which can be used are available over the counter without a prescription. Some prescribed medicines, such as (linaclotide) are only used where treatment failed to deliver expected results, and symptoms of constipation are present for more than 12 months.

Drugs to stop diarrhoea. Patients can purchase IBS medication over the counter to treat diarrhoea, which is the same drugs as prescribed options.

Antidepressants (prescription-only medicines). Antidepressants such as tricyclic antidepressants (TCAs) are a second-line option for the treatment of diarrhoea only if commonly used Loperamide is unsuccessful. This group will not be reviewed in this post as an antidepressant are not available over the counter.

Quick FAQ

What are the best IBS treatments?
Cognitive Behavioural Therapy has been an effective way to treat IBS. This therapy can be provided by a mental health care professional.
At what age does IBS usually start?
IBS affects 15% of adults in the US, and women are twice as likely to be affected by it than men. The most common age is between 20 and 30.
Is IBS life-threatening?
IBS is not life-threatening, but it also has no known cure.
Do probiotics with IBS?
Probiotics may relieve bloating and other overall symptoms in some people.

Antispasmodic and anticholinergic drugs for IBS associated cramps and spasm

IBS Over The Counter Medicine: Treatment Of Constipation

I reviewed over the counter laxatives in the post ‘The Best Over The Counter Laxatives (UK)‘. As previously mentioned, lactulose should not be used to help with IBS related constipation. Although lactulose is considered as a ‘gentle’ laxative, it may produce gas and cause bloating when taken. Bloating caused by lactulose can make IBS worse.

IBS Medication Over The Counter: Bulk-Forming Laxatives

Bulk-forming laxatives are considered as the first-line treatment of constipation in IBS. Their mechanism of action is simple –soluble fibre contained in the formulation increases of faecal mass, which makes the stool softer, more comfortable to pass, and regularly. If needed, the dose of bulk-forming laxatives can be adjusted according to the response.

Two main ingredients found in bulk-forming laxatives are ispaghula husk (also known as psyllium), sterculia, or methylcellulose. Both active ingredients are recommended to those who lack fiber in their diets.

Key points on the use of bulk-formin laxatives:

  • Bulk-forming laxatives take a few days to work, usually 2-3 days
  • Bulk-forming laxatives should not be taken at night, before going to bed
  • Patients need to make sure that plenty of water (fluids) when bulk-forming laxatives are used.
  • Bulk-forming laxatives should not be used to treat constipation caused by drugs, such as Co-codamol or other codeine-based drugs.
  • Bulk-forming laxatives can cause flatulence and bloating.

Most popular over the counter bulk-forming laxatives

Fybogel

Fybogel

Fybogel comes in granules, which are firstly mixed with water and then consumed. Fybogel range includes:

  • Fybogel Orange Granules
  • Fybogel Plain Granules
  • Fybogel Hi-Fiber Lemon Granules
  • Fybogel Hi-Fiber Orange Granules

Most pharmacies keep Fybogel as a part of their dispensing stock. Customers may need to get larger Fybogel packs from a pharmacy counter as products available for self-selection may be smaller in size.

1. Fybogel Orange Granules

2. Fybogel Hi-Fiber Orange

3. Fybogel Plain Granules

Fybrogel is a popular pharmacy product that contains ispaghula husk (psyllium husk); however, there are plenty of supplements that can be purchased online, for example, on Amazon.co.uk, which include the same ingredients and are a source of dietary fibre. Some of them may be cheaper than the Fybogel brand.

A couple of popular examples:

4. Ispaghula Husk Orange Drink

Ispaghula-Husk-Orange-Drink

Looking briefly at reviews, many customers find Fybogel of more acceptable taste.

Ispaghula Husk Orange Drink is a very similar product to Fybogel, providing for the same amount of ispaghula husk per serving - 3.5g.

It comes in same size box containing 30 sachets. Although this product is cheaper than Fybogel, the flavour may be compromised a little bit.

5. Lepicol High Fibre Psyllium Husk

Lepicol-High-Fibre-Psyllium-Husk

Psyllium husk is another name for ispaghula husk. Lepicol has a rather unique formula of three different ingredients:

  • Psyllium husk
  • Live bacteria
  • Insulin (a fibre from chicory root and not the Insulin produced by the pancreatic cells)

As advertised the Insulin (chicory root) is not broken down by the body, but fermented by live bacteria to support the growth of natural bacterial flora in the gut. Live bacteria help to maintain microflora in the gut.

I questioned whether any of the bacteria included in the Lepicol survive the stomach’s acid environment, where digestion happens. The manufacturer of Lepicol replied to my query, explaining that bacteria are encapsulated during the freeze-drying process (to preserve bacteria), which protects bacteria from the acidic environment as confirmed by a laboratory test.

Nevertheless, this is an interesting and unique combination product that helps with constipation.

6. Methylcellulose For IBS (Celevac)

Methylcellulose-For-IBS-(Celevac)

Methylcellulose is less commonly prescribed and requested over the counter.

There is only one product used for constipation which contains methylcellulose called Celevac.

Some pharmacies may stock Celevac. One would definitely need to ask about it at the pharmacy counter.

Celevac is licensed for the treatment of constipation, control appetite, and the treatment of obesity.

Although Celevac tablets are no longer available, there are a few Celevac alternatives options to consider. The best alternative products are chosen based on their intended use.

IBS Drugs For The Treatment Of Diarrhoea

The most popular drug in the UK for the management of diarrhea is Loperamide (brand name: Imodium). Loperamide is widely available over the counter from pharmacies and supermarkets.

Loperamide is usually taken when fast symptom control is required.

7. Generic Loperamide

Getting Loperamide online is probably the cheapest option for customers. Patients who may need to use Loperamide regularly after a recommendation from a doctor may benefit from having Loperamide prescribed, as a GP can issue larger quantities. Plenty of generic brands is available on Amazon.co.uk, which are generally cheaper than Loperamide found in supermarkets and pharmacies.

8. Imodium IBS Relief

For the symptomatic treatment of acute episodes of diarrhoea associated with Irritable Bowel Syndrome in adults aged 18 years and over following initial diagnosis by a doctor.

Imodium-IBS-Relief
I will add a few comments about Imodium IBS Relief.

Although this product is marketed for the treatment of IBS related acute diarrhoea, it does not differ from other loperamide products

other than its availability as a general sale item (item which can be purchased in any retail shop) and additional licensed indication, which states:

Each Imodium IBS Relief capsule contains 2 mg loperamide hydrochloride, which is a standard amount of Loperamide.

IBS Drugs For The Management Of Cramps And Spasm

Fybogel

I recently reviewed two drugs used for symptomatic management of crams and stomach pain in IBS.

Buscopan Cramps, Buscopan IBS Relief, and Colofac are IBS medications available over the counter.

Buscopan and Colofac contain two different active ingredients; however, they produce a very similar effect of muscle relaxation alongside the gastrointestinal tract, helping with symptoms of IBS.

  • Buscopan Cramps and Buscopan IBS Relief tablets contain 10mg of hyoscine butylbromide.
  • Colofac IBS tablet contains 135mg of mebeverine hydrochloride.

9. IBS Medication Over The Counter: Buscopan Cramps And IBS Relief

Buscopan Cramps and Buscopan IBS Relief are the same medication. Both products contain hyoscine butylbromide as an active ingredient.

The only difference is the use restrictions which are attached to Buscopan IBS Relief. Buscopan IBS Relief is recommended for patients with confirmed IBS, and it is usually available in stores and pharmacies for customer self-selection. Buscopan Crams, on the other hand, is a pharmacy-only medication.

10. Buscopan IBS Relief

11. Colofac IBS

Colofac IBS is a pharmacy-only product, with sales restricted to pharmacies and online chemists only. Colofac IBS contains mebeverine hydrochloride. NICE guidelines of the management of IBS informs that mebeverine (Colofac IBS) is preferred drug of choice over antimuscarinic drugs such as hyoscine butylbromide (Buscopan), as it is less likely to cause side effects (BNF, 2017).

Antispasmodics drugs should theoretically improve IBS symptoms by reducing muscle contractions and spasm (Chang, 2014).

12. Peppermint Oil For IBS

Peppermint-Oil-For-IBS

Similarly to Colofac IBS, Peppermint Oil can be classified as antispasmodic.

Peppermint oil relaxes gastrointestinal smooth muscle, helping with symptoms of spasms and cramps.

Similarly to Colofac IBS, Peppermint Oil can be classified as antispasmodic. Peppermint oil relaxes gastrointestinal smooth muscle, helping with symptoms of spasms and cramps.

Several studies showed benefits of peppermint oil (over a placebo – a dummy pill) in controlling IBS symptoms such a muscle spasm and abdominal pain (NICE, 2017).

Peppermint oil became a popular ingredient in many IBS ‘relief’ products.

One of the most common brands of peppermint oil dispensed in pharmacy is Colpermin capsules. Colpermin is available in two boxes sizes: 100 capsules

There are plenty of options (better value for money) available on Amazon.co.uk which contain the same amount of peppermint oil as Colpermin and other ‘generic’ product:

13. Senocalm IBS Relief Prevention

Senocalm IBS Relief takes advantage of two active ingredients in the formulation – peppermint oil and simethicone. The benefit of peppermint oil in the treatment of IBS was already discussed.

Simeticone mainly helps with bloating. Simeticone joins larger gas bubbles inside the gastrointestinal tract, which are then dispersed, allowing removal from the body.

Quite rightly, Senocalm IBS Relief is advertised as a product to help relieve and prevent:

  • bloating,
  • discomfort,
  • painful spasms and
  • cramps

14. Silicolgel For IBS

Last but not least, I will talk about Silicolgel. Silicolgel is a popular product used to treat a range of gastrointestinal symptoms, including:

  • Heartburn
  • Acid reflux
  • Vomiting

.. and additionally, IBS symptoms of:

  • Nausea
  • Flatulence
  • Stomach ache
  • Discomfort
  • Diarrhoea

Silicolgel coats the stomach with a protective gel layer made of colloidal silicic acid, which attracts irritants, gases, and toxins, removed from the body. Although no clinical evidence exists to support the effectiveness of this product, Silicolgel has overall some great reviews from patients with IBS symptoms.

IBS Pain Management With Over The Counter Drugs

UK guidelines on IBS do not mention any drugs for managing the pain. Medications reviewed in this post should ease the symptoms and associated pain.

Conventional pain killers, which are available over the counter, for example, paracetamol, ibuprofen or co-codamol are generally not suitable for patients with irritable bowel syndrome. Prescribed drugs such as tricyclic antidepressants and other drugs such as gabapentin and pregabalin can moderately improve IBS symptoms (Chen, 2017).

IBS Medication Over The Counter – Conclusion

Nice guidelines on IBS management focus on lifestyle changes with possible pharmacotherapy with anticholinergic, antispasmodic, and other drugs. IBS medication available over the counter offers a good choice for managing IBS symtoms. Additionally, over-the-counter combination products that are not mentioned in the IBS guidelines may offer symptomatic treatment benefits, which have not been clinically reviewed yet.

References
  • Chey, W.D., Kurlander, J. and Eswaran, S., 2015. Irritable bowel syndrome: a clinical review. Jama313(9), pp.949-958. Available at: https://jamanetwork.com/journals/jama/article-abstract/2174034 Accessed on 29/09/2020.
  • Chang, L., Lembo, A. and Sultan, S. (2014) American Gastroenterological Association Institute Technical review on the pharmacological management of irritable bowel syndrome. Gastroenterology 147(5), 1149-1172. Available at: https://doi.org/10.1053/j.gastro.2014.09.002 Accessed on 29/09/2020.
  • Chen L, Ilham SJ, Feng B. Pharmacological Approach for Managing Pain in Irritable Bowel Syndrome: A Review Article. Anesth Pain Med. 2017 Jan 25;7(2):e42747. doi: 10.5812/aapm.42747. PMID: 28824858; PMCID: PMC5556397. Available at: https://doi.org/10.5812/aapm.42747 Accessed on 03/10/2020.