1. Background
1.1. Idiopathic constipation associated w/ chronic or recurrent abdominal discomfort that is relieved by defacation is IBS-C
2. Drug Tx
2.1. 1st-line: bulk-forming agents
2.1.1. Also preferred in pregnancy
2.1.2. Absorb water in intestine which :arrow_up: peristalsis & :arrow_down: transit time
2.1.2.1. Psyllium (metamucil)
2.1.2.2. Wheat dextrin (Benefiber)
2.2. Osmotics
2.2.1. Contain large ions or moleculs that aren't absorbed; draw fluid into bowel lumen which distends colon & :arrow_up: peristalsis
2.2.1.1. Mag hydroxide (Milk of Mag)
2.2.1.2. PEG 3350 (Miralax)
2.2.1.3. Lactulose
2.2.1.3.1. Used commonly for hepatic encephalopathy
2.3. Stimulants
2.3.1. Stimulate neurons in the colon
2.4. Stool softeners
2.5. Chloride-channel activator
2.5.1. **Lubiprostone (Amitiza)**
2.5.1.1. Take w/ food & water
2.6. Guanylate cyclase C agonist
2.6.1. **Linaclotide (Linzess)**
2.6.1.1. Do not use in peds
2.6.1.2. Original container has a desiccant
3. OIC
3.1. PAMORAs (antagonists)
3.1.1. **Alvimopan (Entereg)**
3.1.1.1. BBW: Risk of MI w/ long-term use; REMS
3.1.1.2. Do not use longer than 7 consecutive days
3.1.2. **Methylnaltrexone (Relistor)**
3.1.3. **Naloxegol (Movantik)**
4. Diarrhea
4.1. **Loperamide (Imodium A-D)**
4.1.1. BBW: Torsades, cardiac arrest, & sudden death
4.1.2. C/I: acute dysentery, pseudomembranous colitis, bacterial enterocolitis
4.1.3. 4mg PO after 1st loose stool, then 2mg after each subsequent loos stool
4.1.3.1. Max 16mg/day under supervision
4.1.3.2. Do not use more than 48 hrs
4.2. **Diphenoxylate/atropine (Lomotil)**
4.2.1. C-V
4.2.2. Max 20mg/day
4.3. **Dicyclomine (Bentyl)**
4.3.1. ANtispasmodic
4.3.2. Anticholinergic
4.4. **Eluxadoline (Viberzi)**
4.4.1. C-IV
4.4.2. PAMORA (agonist)
4.4.3. C/I: pts without a gallbladder