Selecting medications for patients with IBS (Irritable Bowel Syndrome) can be challenging.  It is first most important to ask about or understand the patient’s IBS symptoms.  Identifying if the patient has more diarrhea or constipation is a really important thing to assess.

Example 1: Let’s say a patient has fibromyalgia and you are trying to determine which therapy is most appropriate.  If the patient has severe constipation associated with their IBS, using a TCA which could exacerbate constipation may not be a great first line choice.  Instead, maybe an SNRI or gabapentin would be utilized.

Example 2: Your patient has severe diarrhea associated with their IBS.  In management of depression, we certainly have lots of options to choose from.  In this situation, a drug like sertraline which tends to cause more loose stools than constipation should likely be avoided over other alternatives that would be less likely to exacerbate diarrhea.

Example 3: Colchicine is not a medication that is used frequently for gout exacerbations/prophylaxis, but it is an option.  This would be another example of a medication that we should likely avoid in a patient with IBS and predominant diarrhea.  On the flipside the colchicine adverse effect of diarrhea could be advantageous in a patient that struggles with constipation.

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