What pharmacological treatments are recommended for managing IBS symptoms, and how should they be prescribed?

For managing IBS symptoms, pharmacological treatments include antispasmodic agents, which should be taken as required alongside dietary and lifestyle advice ¹.

Loperamide is recommended as the first choice of antimotility agent for diarrhoea in IBS ¹.

People with IBS should be advised to adjust their doses of laxatives or antimotility agents according to clinical response, aiming for a soft, well‑formed stool (Bristol Stool Form Scale type 4) ¹.

Consider linaclotide for people with IBS‑constipation if maximum tolerated doses of previous laxatives have not helped and they have had constipation for at least 12 months; follow-up should occur after 3 months ¹.

For persistent symptoms, a trial of antidepressants such as tricyclic antidepressants (TCAs) can be considered, starting at a low dose (5–10 mg equivalent of amitriptyline) taken at night, with regular review ².

SSRIs should only be considered if TCAs are ineffective, with similar cautious dosing and follow-up ².

Psychological interventions like CBT or hypnotherapy may be considered if pharmacological treatments are ineffective after 12 months ¹.