About Trulance In Canada
TRULANCE is a guanylate cyclase-C agonist, which mimics the effect of natural hormones in the body, giving it a unique method of action which allows it to act in the small intestine in a pH-sensitive manner to facilitate fluid secretion, increase intestinal transit, and decrease the activity of pain-sensitive nerves in the intestines.14 In clinical studies, TRULANCE provided a statistically significant patient self-evaluated reduction in IBS disease severity and a statistically significant reduction in IBS symptoms versus placebo.15 In the two clinical trials on which the approval of TRULANCE was based, 30.2 per cent and 21.5 per cent respectively of TRULANCE patients were considered overall responders, meaning they experienced both a significant decrease in abdominal pain and a significant increase in complete spontaneous bowel movements compared to those on placebo.16 In clinical trials, the incidence of serious adverse events in patients using TRULANCE was low and similar to that recorded in the placebo arm of the studies.17 TRULANCE has not been studied in or approved for patients under the age of 18.18
Medications Currently Available For The Treatment Of Irritable Bowel Syndrome
The literature search resulted in 43 studies meeting the inclusion criteria that assessed the efficacy of medications for the treatment of IBS. Table 2 describes the studies that met inclusion criteria and their respective outcomes, whereas table 3 describes the overall efficacy of each medication by IBS type and symptom. With few exceptions, many of the studies were limited by short treatment duration and follow-up, imprecise or variable methods of identifying IBS and subtype, and small sample sizes. Medications with the most robust evidence supporting their use for the treatment of IBS were lubiprostone, linaclotide, rifaximin, fiber supplementation and peppermint oil. Table 4 describes the proposed mechanism of action of the medications for treating IBS.
Table 2
Placebo-controlled trials assessing the efficacy of medications for the treatment of IBS symptoms
Table 3
Efficacy of medications for the treatment of specific IBS symptoms: clinical outcomes of placebo-controlled trials
Table 4
Mechanism of action of medications for the treatment of IBS
Lubiprostone
Given the clear evidence supporting the use, lubiprostone appears as a viable and preferred option for the treatment of IBS-C. Limiting lubiprostone’s use are its high cost and lack of long-term studies.
Linaclotide
Given the robust evidence supporting the use of linaclotide, linaclotide is a viable option for the treatment of IBS-C. Limitations of linaclotide’s use are its high cost and lack of long-term studies.
Who Is More At Risk Of Ibs
Nobody knows what causes IBS but certain risk factors make you more likely to get the condition. The condition is more common in:
- People under the age of 45 years
- Those who already have a family member with IBS
- People under psychological stress, such as that associated with anxiety, depression, personality disorder, or a history of sexual abuse.
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Ibs Diagnosis Treatment And Covid
IBS is functional disorder of the gastrointestinal tract, meaning it is caused by a problem with the way the gastrointestinal tract works. It usually affects the lower GI area, which includes the small intestine, large intestine, and colon.
Patient with IBS typically do not have any signs of damage or disease in the intestinal tract damage, but rather suffer from a constellation of symptoms that occur together such as repeated pain in the abdomen, changes in bowel movements, feeling gassy, bloated, chronic diarrhea, constipation and, in some cases, both.
Estimates suggest that IBS affects between 25 and 45 million people in the United States, approximately 10 to 15 percent of the population. More women than men are impacted by IBS though it can affect anybody, including children. The most common onset age, however, is between 20 30 years old.
While IBS can cause significant distress and discomfort to those affected, people do not typically experience severe complications as a result of the condition or a need for surgery, said Andrew Sable, MD of Gastro Health Florida. Successful treatment depends on a close and on-going relationship with your physician as well as lifestyle and dietary changes and the use of medications.
About Bausch Health Companies Inc
Bausch Health Companies Inc. is a global company whose mission is to improve peoples lives with our health care products. We develop, manufacture and market a range of pharmaceutical, medical device and over-the-counter products, primarily in the therapeutic areas of eye health, gastroenterology, and dermatology. We are delivering on our commitments as we build an innovative company dedicated to advancing global health. In Canada, the Companys prescription product portfolio is focused on eye health, dermatology, and cardio-metabolic conditions. More information can be found on the Companys website at bauschhealth.ca.
1. Bausch Health, Canada, Understanding Patients Perceptions and Treatment Habits of IBS-C, research report by Callosum, October 2021, p. 15.
2. Bausch Health, Canada, TRULANCE Product Monograph dated March 17, 2021, Indications, p. 4.
3. Moayyedi P et al, Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable Bowel Syndrome , Journal of the Canadian Association of Gastroenterology, 2019, 2, 629.
4. Bausch Health, Canada, Understanding Patients Perceptions and Treatment Habits of IBS-C, research report by Callosum, October 2021, p. 15.
5. Bausch Health, Canada, Understanding Patients Perceptions and Treatment Habits of IBS-C, research report by Callosum, October 2021, p. 14.
7. Gastrointestinal Society. 2016 Survey Results Irritable Bowel Syndrome ..
9. Ibid.
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Laxatives Should Only Be Used Sporadically For Ibs
Fiber supplements and laxatives are often the first things doctors recommend to treat constipation. Laxatives do not cure constipation, and the longer you use them, the more difficult it is to get by without them. Laxatives should only be used very temporarily and sporadically at the most.
If you need laxatives in order to have a bowel movement, then you have IBS and would be better served to find the cause of the problem and eliminate your need for laxatives as soon as possible.
Some drugs used to treat constipation include:
- Linzess is a popular, well-advertised medication used in the treatment of constipation. It can cause diarrhea, abdominal pain, heartburn, vomiting, gas, bloating, headaches, and cold symptoms.
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Progress In Research For Investigational Drugs For Irritable Bowel Syndrome
A number of medications for the treatment of IBS are currently in the research pipeline. Some of these medications are currently available for other indications and others are investigational drugs. Further, there are medications available in certain countries that are effective and used for the treatment of IBS, including ramosetron.
A review of clinicaltrials.gov, using the search terms irritable bowel syndrome’ and IBS’, identified 22 investigational drugs for the treatment of IBS with ongoing investigation into their utility as a potential treatment . The investigational drug names, proposed mechanism of action and phase in drug development are listed in table 6. Further, there are 18 drugs that are currently available in the USA that are being studied in clinical trials listed on clinicaltrials.gov for the indication of IBS . Of these medications, 10 have no prior studies assessing their efficacy for the treatment of IBS, which include mesalamine for IBS-D and IBS-A, duloxetine for IBS-A with comorbid depression, crofelemer for IBS-D, milnacipran for IBS-A, escitalopram for IBS-A, dronabinol for IBS-A, colesevelam for IBS-D, nortriptyline for IBS-A, polyethylene glycol for IBS-C, and mexiletine for IBS-A. The remaining 8 currently available drugs being studied in clinical trials to better define their role in therapy for IBS and include pregabalin, rifaximin, citalopram, doxepin, paroxetine CR, alosetron, tegaserod, and desipramine.
Table 6
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Supplements And Medications For Ibs Relief
Medications typically arent the first line of treatment for IBS, but they may be helpful for people with moderate to severe symptoms who have tried different dietary strategies without success.
Depending on your symptoms, your doctor may prescribe one or more of the following remedies.
Fiber supplements If increasing fiber in your diet isnt effective, you can take a variety of supplements containing different forms of soluble fiber. This is particularly helpful for people who experience constipation.
Smooth muscle relaxants These drugs can help with intestinal cramping, abdominal pain, and bouts of diarrhea, but its best to talk to your doctor if you plan to use them frequently or regularly. In some cases, though, they may cause constipation. The guidelines recommend against the use of antispasmodics currently available in the United States to treat global IBS symptoms.
Antidiarrheal drugs
Pain relievers Certain drugs that act on the brains pain sensory mechanisms may help ease severe abdominal pain or bloating while the root causes are explored. Opiate medications like oxycodone, codeine, and others are not recommend for chronic use to manage IBS symptoms and can actually worsen the overall disease.
IBS-specific drugs
Complementary Approaches To Consider
The evidence in favor of various complementary approaches and therapies for IBS is mixed. Talk to your doctor before trying any of the following treatments to understand the potential benefits and risks and how they might fit with your mainstream care plan.
ProbioticsAcupunctureBioScience TrendsPeppermintMeditation and mind-body practicesNeurogastroenterology and Motility
Additional reporting by Jordan Davidson.
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Ibs Medications For Cramping
Stomach cramps or abdominal spasms are common symptoms of IBS. They are often in the lower half of the belly, but can be in the the middle or upper abdomen. Some people get worse after meals and feel better after a bowel movement.
- Hyoscyamine is an antispasmodic drug that has been around since the 1950s. It is used to treat abdominal cramping. Side effects include constipation, bloating, heartburn, nausea, insomnia, dizziness, and headaches, as well as many others.
Cost And Affordability Of Medications
While prescription pharmacologic therapy is the mainstay of treatment for IBS-C, these medications come with a hefty price tag. Optimizing first-line nonpharmacologic and alternative treatment options may help prevent patients from needing to use the expensive prescription medications. Psyllium fiber is both an inexpensive and easily accessible OTC recommendation to use initially in patients with IBS-C as it improves overall symptoms. While a trial of the low FODMAP diet may incur the initial added cost of a dietician, patients who have symptom improvement from the diet can be identified within 2 to 6 weeks.1 Those who dont see an improvement in abdominal pain and bloating during this limited trial can move on to other treatment modalities, whereas patients that do respond can continue to work with their dietitian and potentially lower their overall medication cost long-term. PEG could be considered as well, given that it is inexpensive and improves stool frequency and consistency. In those looking to minimize cost, PEG could be used for its laxative effect in combination with other approaches, such as peppermint oil and GDPs, to help with abdominal pain.
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Ibs Treatment Center Finds The Root Cause Of Ibs Symptoms: To Cure Your Ibs By Finding The Root Cause Not Just Relieving Symptoms
At the IBS Treatment Center, we rarely use any of these medications. Other than antibiotics for bacterial overgrowth, and enzymes for pancreatic insufficiency, the medications listed above have clearly demonstrated their inability to cure IBS. Even worse, almost all these drugs have the potential to make IBS worse.
Our goal is to end IBS symptoms for the long term. To do this, we work to find the true cause of a patients problem, not just treat the symptoms. Once we find the underlying cause of the IBS, we can treat it and the symptoms will end, not just be masked by the quick fix of a prescription.
After treatment at our facility, most of our patients are ultimately able to discontinue the use of any previously prescribed medications for their digestion. It is usually a natural transition for a patient to cut back on the meds as they heal and begin to feel better. Without the symptoms, the need to suppress them with medications disappears.
IBS is a complex disorder with a variety of symptoms and causes. There is no one-size-fits-all cause or cure for IBS. Finding your cure requires an experienced medical expert like those at IBS Treatment Center who will spend the time to understand your unique situation and work with you to find the right treatment plan.
SEATTLE IBS TREATMENT CENTER
Diarrhea Compared To37% Placebo
Target 1 & 2 Study Design: Two identical, randomized, phase 3 trials conducted over a 3-month period. A total of 1258 patients meeting Rome II criteria for IBS received XIFAXAN 550 mg 3 times a day or placebo for 14 days. Primary endpoint was adequate relief of IBS signs and symptoms for at least 2 of 4 weeks during the month following 14 days of treatment. Adequate relief was defined as a response of yes to the weekly Subject Global Assessment question: In regards to your IBS symptoms, compared to the way you felt before you started study medication, have you, in the past 7 days, had adequate relief of your IBS symptoms? .Primary endpoint: 41% of patients in the XIFAXAN 550 mg group, 31% of TARGET 1 placebo group and 32% of TARGET 2 placebo group experienced adequate relief of IBS signs and symptoms. Composite endpoint was defined as 30% decrease from baseline in abdominal pain with a weekly average stool consistency score of < 4 for 2 weeks during the month following 2 weeks of treatment.
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The Benefits Of Talking With A Therapist For Ibs
For many people with IBS, emotional stress plays an important role in the frequency and severity of their symptoms.
Its important to have a discussion with your doctor about how stress might be contributing to your symptoms. If you both agree that stress, anxiety, or depression could be affecting your IBS, you may be referred to a mental health professional.
When you see a therapist, the following strategies may be used to improve your symptoms. It could also be beneficial to have a multidisciplinary team to support you, in which your doctor-led care includes a nutritionist and mental health professional, for example.
Cognitive behavioral therapy This type of talk therapy focuses on helping you change your patterns of thought and behavior. Years of research support its effectiveness as a treatment for IBS.
Gut-directed psychotherapyRelaxation training
Alternative Therapy For Ibs
Some people with IBS try alternative therapies such as acupuncture, probiotics, and herbs to relieve their symptoms.
Keep in mind that most alternative therapies haven’t been tested for effectiveness in rigorous clinical trials the way other treatments have.
Researchers at the National Institutes of Health have found that acupuncture works for chronic pain. For IBS relief, however, the results have been mixed.
There is also some evidence that probiotics, “healthy” bacteria normally found in the gut, help some people with IBS. A study of one type, Bifidobacterium infantis, found that it improved IBS symptoms and day-to-day life after people took it for 4 weeks. Research on another type, lactobacillus, has had more mixed reviews.
Studies on herbs have been mixed. Some research has shown that peppermint relaxes colon muscles and may improve symptoms of IBS.
If you want to try acupuncture or herbs for your IBS symptoms, talk with your doctor first. Some herbs can affect how well other medications work.
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Physical And Behavioural Therapies
Pelvic floor dysfunction is underdiagnosed among patients with irritable bowel syndrome, especially those with the constipation subtype.32 These patients either fail to relax the pelvic floor or paradoxically contract the pelvic floor muscles causing obstructed defaecation.33 Through a technique referred to as biofeedback, physiotherapists with expertise can retrain patients to use their pelvic floor muscles appropriately. Patients are given visual or tactile awareness of involuntary bowel function in order to learn voluntary control.34 Behavioural aspects that contribute to symptoms such as incorrect toileting posture, prolonged time spent in the toilet and the use of inappropriate cues to trigger the need to defecate are also addressed with exercises and biofeedback.35 Selecting patients for this therapy is best determined by specialists with expertise in the diagnosis of irritable bowel syndrome.
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How Should I Take Linzess
Take Linzess exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.
Take Linzess in the morning on an empty stomach, at least 30 minutes before your first meal.
Swallow the capsule whole and do not crush, chew, break, or open it.
If you cannot swallow a capsule whole, open it and sprinkle the medicine into a spoonful of applesauce or bottled water. Swallow the mixture right away without chewing. Do not save it for later use.
Even if you have taken this medicine with applesauce, wait at least 30 minutes before eating a full meal.
If needed, medicine from the Linzess capsule may be given through a nasogastric or gastronomy tube.
Carefully follow instructions for mixing medicine from the capsule with applesauce or water, or giving the medicine through a feeding tube. Ask your doctor or pharmacist if you have any questions.
It may take up to 2 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve.
Store at room temperature away from moisture and heat. Keep the tablets in their original container, along with the packet or canister of moisture-absorbing preservative.
Keep this medicine out of the reach of children. Linaclotide can be fatal to a child who accidentally swallows this medicine. Seek emergency medical attention if this happens.
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