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Evidence-based recommendations on eluxadoline (Truberzi) for treating irritable bowel syndrome with diarrhoea in adults.

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Why have I been started on this medicine?

Eluxadoline is recommended as an option for treating irritable bowel syndrome with diarrhoea (IBS-D) in adults, only if:

  • The condition has not responded to other drugs such as loperamide (Imodium), hyoscine (Buscopan), alverine or amitriptyline.
  • Other drugs are contraindicated or not tolerated.
  • It is started by a consultant gastroenterologist.
What is IBS-D?

It is the combination of abdominal pain, bloating, loose frequent stools often with faecal urgency in the absence of structural, inflammatory, or biochemical abnormalities. It affects about a third of people with IBS.

How does it work?

It is an opioid receptor agonist and delta-opioid receptor antagonist that binds to opioid receptors in the gut thereby slowing movement & decreasing awareness of pain.

Does it work?

The results of large well-conducted trials suggest about 30% of patients with IBS-D responded to the drug compared with about 20% taking placebo. There was a significant improvement in abdominal pain, diarrhoea and faecal urgency.

How is it taken?

100 mg taken by mouth twice daily.

How long does it take to work?

Within the first week symptoms should start to improve with peak benefit by 6 weeks.

How long will I be taking it?

Stop eluxadoline at 4 weeks if there is inadequate relief of the symptoms of IBS-D. Results from trials confirmed benefit for up to 6 months.

What are the common side effects?

The most common adverse effects are nausea, constipation and abdominal pain. Rarely the drug may case pancreatitis (0.3%) or spasm of the sphincter of Oddi leading to pain and a rise in liver enzymes (0.5%). The latter was more common in patients without a gallbladder.

Pregnancy and breast feeding

It is not recommended in pregnancy, in patients planning a pregnancy and should be avoided if breastfeeding