Journal of Neurogastroenterology and Motility : eISSN 2093-0887 / pISSN 2093-0879

Table. 1.

Characteristics of the Novel Drugs Recommended in the American Gastroenterological Association Guidelines for Irritable Bowel Syndrome With Constipation and Irritable Bowel Syndrome With Diarrhea

Drug Mechanism Daily dose FDA approval Comments
Linaclotide GC-C agonists

290 μg qd

72 or 145 μg qd

IBS-C (2012)

CC (2017)

Antinociceptive effects

3 mg qd

3 mg qd

IBS-C (2016)

CC (2017)

Antinociceptive effects
Tenapanor NHE3 inhibitor 50 mg bid IBS-C (2019) Antinociceptive effects
Lubiprostone ClC-2 activator

8 μg bid

24 μg bid

24 μg bid

IBS-C (2008, female only)

CC (2006)

OIC (2013)

Tegaserod Partial 5-HT4 agonist 6 mg bid

IBS-C (Approved for female IBS-C in 2002, for male and female CC in 2004 < 65 years of age

→ Withdrawn in 2007 due to CV ischemic events

→ Reapproved in 2019 for female IBS-C < 65 years of age and without a history of MI, stroke, TIA, or angina)

The manufacturer withdrew tegaserod from the market for a second time in 2022 due to business-related, not safety, issues
Prucalopride Full 5-HT4 agonist

2 mg qd

If CrCL < 30 mL/min, 1 mg qd

CC (2018)

No FDA approval for IBS-C

Prucalopride was not included in the AGA IBS-C guideline because of the lack of RCT for IBS
Eluxadoline Mixed MOR and KOR agonist and DOR antagonist 100 mg bid IBS-D (2015)

5 pancreatitis and 8 SOS events in clinical trial

Contraindicated in patients without a GB or those who drink > 3 alcoholic beverages/day

Rifaximin Antibiotics 550 mg 3 tid for 14 days IBS-D (2015)
Alosetron 5-HT3 antagonist

0.5 mg bid

If constipation occurs, stop and restart 0.5 mg qd

If the symptom is not controlled, 1 mg bid

IBS-D (Approved 9 Feb 2000 → Withdrawn 28 Nov 2000 → Reapproved in 2002 for female only)
Ramosetron 5-HT3 antagonist

5 μg, max 10 μg, qd for male

2.5 μg, max 5 μg, qd for female

No FDA approval for IBS-D Approved in 2008 in Japan for IBS-D

FDA, Food and Drug Administration; GC-C, Guanylate cyclase-C; IBS-C, irritable bowel syndrome with constipation; CC, chronic idiopathic constipation; NHE3, sodium/hydrogen exchanger isoform-3; ClC-2, type-2 chloride channel; OIC, opioid-induced constipation; 5-HT4, 5-hydroxytryptamine receptor 4; CV, cardiovascular; MI, myocardial infarction; TIA, transient ischemic attack; CrCL, creatinine clearance; AGA, American Gastroenterological Association; RCT, randomized clinical trial; MOR, μ-opioid receptor; KOR, κ-opioid receptor; DOR, δ-opioid receptor; IBS-D, irritable bowel syndrome with diarrhea; SOS, Sphincter of Oddi spasm; GB, gallbladder; qd, once a day; bid, twice a day; tid, three times a day.

J Neurogastroenterol Motil 2024;30:4~6
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