{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T21:53:46Z","timestamp":1790805226517,"version":"4.1.0"},"reference-count":49,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2016,3,11]],"date-time":"2016-03-11T00:00:00Z","timestamp":1457654400000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:p>Diarrhea\u2010predominant irritable bowel syndrome (<jats:styled-content style=\"fixed-case\">IBS<\/jats:styled-content>\u2010D) is one of the most common diagnoses made by gastroenterologists. Current pharmacologic treatments for <jats:styled-content style=\"fixed-case\">IBS<\/jats:styled-content>\u2010D include fiber supplements, antidiarrheal over\u2010the\u2010counter medications, probiotics, antispasmodics, antidepressants, and a 5\u2010hydroxytryptophan 3 receptor antagonist. All of these options have limited efficacy in managing <jats:styled-content style=\"fixed-case\">IBS<\/jats:styled-content>\u2010D.<\/jats:p><jats:p>Rifaximin, a nonabsorbable antibiotic, has been evaluated in patients with <jats:styled-content style=\"fixed-case\">IBS<\/jats:styled-content>\u2010D. In two randomized, double\u2010blind, placebo\u2010controlled phase <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content> trials evaluating rifaximin 550 mg by mouth 3 times\/day for 14 days, the primary efficacy end point was achieved by 9% more patients randomized to the rifaximin group compared with placebo (40.7% vs 31.7%, p&lt;0.001, number needed to treat ~11). The primary efficacy end point was defined as the proportion of patients having adequate relief of global <jats:styled-content style=\"fixed-case\">IBS<\/jats:styled-content> symptoms for at least 2 of the 4 weeks during the primary follow\u2010up period (weeks 3\u20136). In the phase <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content> trial examining the efficacy and safety of repeated courses of rifaximin in patients who responded to the initial 2\u2010week course, rifaximin given for up to two additional courses provided a statistically significant incremental benefit (33% vs 25%, p=0.02).<\/jats:p><jats:p>Eluxadoline is a gut\u2010targeting \u03bc and \u03ba opioid receptor agonist and a \u03b4 opioid receptor antagonist. The dual mechanism of eluxadoline may explain the antidiarrheal and abdominal pain\u2010modulating properties and lack of profound constipation. In two identically designed randomized, double\u2010blind, placebo\u2010controlled phase <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content> studies, 10.3% more patients in an eluxadoline 100 mg by mouth twice\/day group met the primary efficacy end point during the follow\u2010up 1\u201312 week period compared with placebo (p&lt;0.001). The primary efficacy end point was a composite response, defined as improvement in worst abdominal pain and stool consistency at the same time on most (50% or more) days during the follow\u2010up period.<\/jats:p><jats:p>This review evaluates evidence for the use of rifaximin and eluxadoline in patients with <jats:styled-content style=\"fixed-case\">IBS<\/jats:styled-content>\u2010D. Rifaximin provides an additional modality for the management of <jats:styled-content style=\"fixed-case\">IBS<\/jats:styled-content>\u2010D patients; it has mild to moderate efficacy similar to other currently available treatment options. Rifaximin is relatively safe, lacks significant drug\u2010drug interactions, and can be used for up to two additional retreatment courses. This may make rifaximin a possible initial or second\u2010line treatment option. Eluxadoline can also offer relief to patients with <jats:styled-content style=\"fixed-case\">IBS<\/jats:styled-content>\u2010D. While effective, because of several limitations, including drug\u2010drug interactions and drug disease contraindications, as well as current lack of clinical experience, it may be tried as a second\u2010 or third\u2010line agent.<\/jats:p>","DOI":"10.1002\/phar.1712","type":"journal-article","created":{"date-parts":[[2016,3,14]],"date-time":"2016-03-14T00:59:09Z","timestamp":1457917149000},"page":"300-316","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Update on the Management of Diarrhea\u2010Predominant Irritable Bowel Syndrome: Focus on Rifaximin and Eluxadoline"],"prefix":"10.1002","volume":"36","author":[{"given":"Anastasia","family":"Rivkin","sequence":"first","affiliation":[{"name":"Fairleigh Dickinson University School of Pharmacy Florham Park New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergey","family":"Rybalov","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Saint Clare's Hospital Dover\/General Dover New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,3,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2012.02.029"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.11.061"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2005.40674.x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.0954"},{"key":"e_1_2_9_6_1","first-page":"290","volume-title":"Harrison's Principles of Internal Medicine","author":"Owyang C","year":"2015"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12728"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0126438"},{"issue":"1","key":"e_1_2_9_9_1","first-page":"S1","article-title":"American College of Gastroenterology Task Force on Irritable Bowel Syndrome. 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