Prokinetics for IBS: Understanding Treatment Options and Benefits

How Prokinetics Work in Managing IBS Symptoms

IBS discomfort sucks...but there are solutions! 

How many times have you experienced pain and did not want it to go away?? Ummm... Never or almost never! Pain sucks, and we all want it to go away as quickly as possible. While some things can detract or distract you from your pain, there are few, which is why many people turn to medications. Today, I want to talk about an option for you if you have IBS symptoms.  

As a quick recap, irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder that is primarily diagnosed based on symptoms. The pathophysiology of IBS is multifactorial and poorly understood. However, we do know that classic symptoms of IBS include abdominal pain or discomfort along with stool irregularities of form (appearance) and frequency (how often). In other words, it can cause constipation or diarrhea. Other symptoms may include bloating, nausea, etc.  

Prokinetic agents: What are they? 

Some of you may have heard of something called prokinetics. The prefix “pro” typically means forward or promote, and “kinetic” refers to movement. Placed together, this means promoting forward movement. Providers may prescribe this class of medications to assist in moving digested material down the GI tract.

How do prokinetics work, and what are their benefits? 

Prokinetics enhances motility and transit (movement) in the GI tract by boosting and coordinating muscle contractions. These wave-like muscle contractions that push the digested food down the GI tract are called peristalsis, and they move food from the esophagus into the stomach and small intestines. 

Prokinetic agents are used in a variety of GI conditions, including IBS, gastroesophageal reflux disease (GERD), diabetic gastroparesis, and chronic constipation. The reason for this is that these conditions affect the nerves and muscles of the GI tract, which can result in dysmotility (See the 3-part series I wrote on decoding dysmotility: Part 1, Part 2, Part 3). Dysmotility means your food is not moving through the digestive system as it should. 

What prokinetic medications can help my IBS symptoms? 

Prokinetics represents a small subset of medications used for IBS. Since prokinetics work on various conditions/symptoms, there are several medication classes of these, but I will focus on a few pertinent to IBS-C (predominant constipation type).  

It is worth mentioning that some prokinetic agents were used to treat some functional GI disorders years ago but are no longer recommended due to side effects, as reported in a 2017 systematic review. Domperidone is one example, and metoclopramide (Reglan) is still used to treat gastroparesis and heartburn only. Tegaserod (Zelnorm) was also pulled off the market due to cardiac risks but was used for IBS-C in women under age 65. This is why there are few of these to discuss in this article. 

Prucalopride (brand names Motegrity, Resolor) - This prokinetic agent is used to reduce the occurrence of reflux, increase gastric emptying, and improve constipation symptoms. This agent acts on the serotonin receptors to stimulate peristalsis in the intestines. Caution should be advised in those with impaired liver and kidney function. 

Medications linaclotide (brand name Linzess) and lubiprostone (brand name Amitiza) work by increasing fluids secreted in the intestines, making it easier to pass stools.  

• These are also known as secretagogues.  
• Both are used for those suffering with IBS-C. Additionally, linaclotide is also used in those with a diagnosis of chronic idiopathic constipation.  
• Linaclotide should be taken on an empty stomach at least 30 minutes before the first meal of the day. It has also been shown to reduce abdominal pain, and diarrhea is the most common side effect.  
• Lubiprostone is only approved for use in women over age 18 and is also used in opioid-induced constipation and chronic idiopathic constipation. Common side effects are nausea and diarrhea.  

While some patients with IBS-C have success with these agents, they are only effective for some. The good news is that if it works for you, you will not have the associated discomfort accompanying IBS. It is essential to talk with your provider about these drugs and their side effects to ensure it is a good fit for you. 

1. _{Camilleri, M., & Atieh, J. (2021). New Developments in Prokinetic Therapy for Gastric Motility Disorders. Frontiers in pharmacology, 12, 711500.}
2. _{Chang, L., Sultan, S., Lembo, A., Verne, G. N., Smalley, W., & Heidelbaugh, J. J. (2022). AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome with Constipation. Gastroenterology, 163: 118-136.}
3. _{Linaclotide (Rx). (2023).} 
4. _{Lubiprostone (Rx). (2023).}
5. _{Madisch, A., Vinson, B. R., Abdel-Aziz, H., Kelber, O., Nieber, K., Kraft, K., & Storr, M. (2017). Modulation of gastrointestinal motility beyond metoclopramide and domperidone: Pharmacological and clinical evidence for phytotherapy in functional gastrointestinal disorders. Wiener medizinische Wochenschrift, 167(7-8), 160–168.}
6. _{Zelnorm (tegaserod) Notice of Withdrawal from the Market. (2022, June 30). Alfasigma USA.}