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SSRIs ‘best choice’ for IBS

Tricyclic antidepressants and alosetron are associated with a significant number needed to harm in the treatment of individuals with irritable bowel syndrome, a US analysis has found.

Researchers investigated the side-effects of various drugs for the treatment of irritable bowel syndrome with diarrhoea or constipation by reviewing 26 trials of pharmacotherapy that stated adverse events, and the number of patients who dropped out due to these events.

They found that lubiprostone was safe in one of the trials, but tricyclic antidepressants and alosetron were associated with significant numbers needed to harm - defined by the relative risk of experiencing an adverse event that required discontinuation of the therapy - at 18.3 and 19.4 respectively.

An adverse event that resulted in cessation of the therapy occurred in every 2.3 patients taking tricyclic antidepressants who benefitted from a drug, and every 2.6 patients taking alosetron.

Study leader Dr Eric Shah, lecturer at the school of medicine at Texas Tech University Health Sciences entre, US, said: 'Apart from lubiprostone, treatment of irritable bowel syndrome with constipation is limited to small studies - with poor descriptions of side-effects - although lubiprostone and SSRIs appear safe.'


American Journal of Medicine 2012, 4: 381-393


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