Tricyclic Antidepressants (e.g. amitriptyline (Elavil), desipramine (Norpramin), nortriptyline (Pamelor))
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How it works:
Acts on nerves within the gastrointestinal tract, spinal cord, and brain to improve abdominal and bowel symptoms.
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Which symptoms does it help: Overall IBS symptoms including the abdominal pain. TCAs can also slow down the gut transit and improve symptoms of diarrhea.
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How long it takes to see a benefit:
2-4 weeks.
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FDA approved:
N/A
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Dosage:
10-75 mg, Initiate at low dose and increase the dose based on response and tolerability every couple of weeks.
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Special considerations or risks:
Dosage for IBS are usually lower than anti-depressive range. When discontinuing TCAs, gradually taper the dose over 2 to 4 weeks to minimize withdrawal symptoms.
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Most common side effects:
Drowsiness, dry mouth, palpitations, blurred vision, and weight gain.
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Recommendation:
ACG recommends TCAs for overall symptom improvement in IBS patients.
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