Irritable bowel syndrome (IBS) is a common condition which is characterised by smooth muscle spasm alongside the gastrointestinal tract with a range of associated symptoms. Patients who are diagnosed with IBS are usually advised on the lifestyles to minimise the risk of IBS symptoms. Review of diet and lifestyle is one of the first recommendations gives 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 14 best IBS medication 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 diarrhoea
- 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 the management of IBS (NICE, 2017).
IBS – recommended treatments
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 who were 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-fibre foods. Fibre requirement 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.
- 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 (an osmotic laxative) 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 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 fibre in their diets.
Key points on the use of bulk-formin laxatives:
- Bulk-forming laxatives take 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 comes in the form of granules which are firstly mixed with water and then consumed. Fybogel range includes:
- Fybogel Orange Granules
- Fybogel Plain Granules
- Fybogel Hi-Fibre Lemon Granules
- Fybogel Hi-Fibre 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-Fibre Orange
3. Fybogel Plain granules
Fybrogel is popular pharmacy product which contains ispaghula husk (psyllium husk); however, there are plenty of supplements which 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 Fybogel brand.
A couple of popular examples:
4. Ispaghula Husk Orange Drink
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. Looking briefly at reviews, many customers find Fybogel of more acceptable taste.
5. 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 acid environment of the stomach, where digestion happens. 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 which helps with constipation.
6. 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, almost definitely one would need to ask about it at the pharmacy counter. Celevac is not only licensed for the treatment of constipation but also to control appetite and the treatment of obesity.
IBS drugs for the treatment of diarrhoea
The most popular drug in the UK for the management of diarrhoea 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. There are plenty of generic brands available on Amazon.co.uk which are generally cheaper than loperamide found in supermarkets and pharmacies.
8. 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 general sale item (item which can be purchased in any retail shop) and additional licensed indication, which states:
“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.“
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
Recently I reviewed two drugs, which are used for symptomatic management of crams and stomach pain in IBS. Buscopan Cramps, Buscopan IBS Relief and Colofac are IBS medication 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 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 the symptoms of IBS by reducing muscle contractions and spasm (Chang, 2014).
12. 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.
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 100 capsules and a smaller pack of 20 Colpermin 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, for example, BuscoMint and other ‘generic’ product:
13. Senocalm IBS Relief Prevention
Senocalm IBS Relief takes advantage of two active ingredients in the formulation – peppermint oil and simeticone. 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:
- painful spasms and
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:
- Acid reflux
.. and additionally, IBS symptoms of:
- Stomach ache
Silicolgel coats the stomach with a protective gel layer made of colloidal silicic acid, which attracts irritants, gases and toxin, which are 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 does not mention any drugs for the management of 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 the management of IBS focuses on lifestyle changes with possible pharmacotherapy with anticholinergic, antispasmodic and other drugs alongside. IBS medication available over the counter offer a good choice for the management of IBS symtoms. Additionally, over the counter combination products which are not mentioned in the IBS guidelines for IBS may offer symptomatic treatment benefits, which has not been clinically reviewed yet.
BNF 73 (2017) British National Formulary. 73rd edn. London: British Medical Association and Royal Pharmaceutical Society. Irritable bowel syndrome: Antispasmodic drugs. Available at: https://cks.nice.org.uk/topics/irritable-bowel-syndrome/prescribing-information/ahntispasmodic-drugs/ 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
NICE (2017). Irritable bowel syndrome: Scenario: Management of irritable bowel syndrome. Available at: https://cks.nice.org.uk/topics/irritable-bowel-syndrome/management/management/ Accessed on 02/10/2020