Lubiprostone Treatment for IBS-C

Introduction to Lubiprostone

The British Society of Gastroenterology recommends lubiprostone as a second-line treatment for IBS-C, to be used after first-line interventions have failed, with a strong recommendation and moderate quality evidence 1, 2, 3
The American Gastroenterological Association recommends lubiprostone only after patients fail to respond to over-the-counter agents, with a conditional recommendation and moderate certainty of evidence 4, 5, 6, 7

Initial management of IBS-C should begin with dietary modifications, lifestyle changes, and over-the-counter laxatives in primary care settings, according to the British Society of Gastroenterology 1, 2
The American Gastroenterological Association suggests that these foundational interventions must be attempted and proven inadequate before escalating to prescription secretagogues 4, 5, 6, 7

Lubiprostone demonstrated superiority over placebo for the modified FDA composite endpoint, with a relative risk of 0.88 (95% CI 0.79-0.96), as reported by the American Gastroenterological Association 4, 5, 7
The drug improved global response and abdominal pain relief, but the benefits did not meet the threshold for being clinically meaningful, according to the American Gastroenterological Association 4, 5, 7
Nausea is the most frequent side effect, occurring in approximately 35% of patients, though typically mild to moderate, as noted by the American Gastroenterological Association 8

Linaclotide is likely the most efficacious secretagogue for IBS-C, with strong evidence, though diarrhea is more common, as reported by the British Society of Gastroenterology 1, 2, 3
Lubiprostone offers an advantage of being less likely to cause diarrhea than other secretagogues, making it preferable for patients particularly concerned about this side effect, according to the British Society of Gastroenterology 1, 2, 3

The FDA approves lubiprostone specifically for women ≥18 years old with IBS-C at 8 mcg twice daily, as stated by the American Gastroenterological Association 4, 5
Discontinuation rates due to adverse events were similar between lubiprostone and placebo in IBS-C trials, as reported by the American Gastroenterological Association 4, 5, 7
Counsel patients about the high likelihood of nausea and emphasize taking the medication with food and water, as recommended by the American Gastroenterological Association 8