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New research suggests that an inexpensive and common prescription drug used to treat migraine, nerve and back pain, and depression may also help improve irritable bowel syndrome (IBS) symptoms. Dima Berlin/Getty Images
  • An inexpensive and widely available drug called amitriptyline has been shown to improve IBS symptoms
  • The drug was found to be almost twice as effective as a placebo in a recent trial.
  • Amitriptyline may improve IBS symptoms by regulating the nervous system and stopping the reuptake of serotonin by the brain.
  • Experts say this is promising news for people with IBS, but Amitriptyline is not without risk.

New research has found that amitriptyline, a cheap and widely available prescription drug, can improve symptoms of Irritable Bowel Syndrome (IBS).

The research presented Monday at UEG Week 2023 found that doses of the drug (commonly used to treat a range of health concerns, including migraine, nerve and back pain, and depression) could also improve IBS.

Conducted by researchers at the Universities of Leeds, Southampton, and Bristol the study shows that patients taking amitriptyline were almost twice as likely to report an overall improvement in symptoms as those taking a placebo.

During the study, doctors prescribed amitriptyline and patients managed their own dose based on the severity of their symptoms, using an adjustment document designed for the trial.

As a result of the study, the trial team are now recommending that doctors support their patients with IBS to use amitriptyline to manage their symptoms.

“Amitriptyline is an effective treatment for IBS and is safe and well tolerated,” co-chief Investigator Dr. Alexander Ford, Professor of Gastroenterology at the University of Leeds’s School of Medicine, said in a press release. “This new rigorously conducted research indicates that general practitioners should support patients in primary care to try low-dose amitriptyline if their IBS symptoms haven’t improved with recommended first-line treatments.”

The trial team has made an adjustment document available to clinicians and patients.

Jaspreet Randhawa, holistic pharmacist and founder of Whole Body Pharmacist, says the results of this study are “promising” for patients who are living with IBS.

She isn’t surprised that amitriptyline is beneficial for gut issues, as well as many other ailments.

“The results make sense when looking at the method of action of amitriptyline on the nervous system; it works by stopping the reuptake of serotonin by the brain,” she explains. “With 90-95% of serotonin production occurring in the gut, it would seem viable that the gut can be affected by a regular dose of amitriptyline.”

Dr. Semiya Aziz, a general practitioner and founder of Say GP, agrees with this synopsis. She notes that many of the conditions amitriptyline is used to treat are associated with nerve-based issues.

“We know that IBS is a condition which affects the gastrointestinal tract and currently a large amount of research is being carried out on the effects of gut-brain axis and nervous system,” she points out.

“Therefore, it’s not difficult to understand how amitriptyline can help with IBS symptoms when we have used this drug to treat people with nerve-related problems in the past.”

In particular, amitriptyline may play an important role in regulating the vagus nerve.

“Irritation of this nerve can cause vagal nerve dysfunction and possibly IBS symptoms,” Aziz explains.

Effecting both the nervous system and serotonin, Aziz reasons that amitriptyline alleviates IBS symptoms by having an overall calming effect on gut function, relieving pain and causing changes in bowel activity.

So, what does all this mean for how IBS may be treated in the future?

Aziz believes the findings of the study may be an important milestone in helping to relieve individuals who have exhausted all other options of treatment for IBS, especially where IBS has impacted their work, social and daily lives.

“In reality, this is a drug that could easily be prescribed in primary care for patients suffering from IBS because it is cheap and widely available but it has its limitations,” she warns.

In particular, she says it may be difficult for patients to adjust or self-dose themselves safely.

“Realistically if the medication is given out for IBS, it will need to be regularly monitored and dosages adjusted by the patient’s [doctor] or the healthcare support system,” Aziz notes.

Still, Randhawa thinks that amitriptyline can be of great benefit to a proportion of people living with IBS.

“I believe some people will find significant relief of their IBS symptoms and I am confident that [doctors] will be able to assess the patient’s ability to manage their symptoms — and hope they will review frequently to support them on their healthcare journey,” she surmises.

Common IBS symptoms include cramping, bloating, excessive gas, and diarrhea or constipation which can be debilitating and can range from mild to severe.

“In primary care, it is difficult to identify the severity of IBS, so it is difficult to know who would benefit from the treatment the most,” Aziz points out.

Add to that, there is still much uncertainty about the causative factor for IBS.

Aziz says it’s often the result of many factors, such as muscle contractions of the intestine or irritation of the nervous system due to stress or infections.

“Most patients who present in primary care with IBS will present with multifactorial medical issues which may not easily be resolved by using just amitriptyline alone,” she explains.

Therefore, it can be difficult to know just how effective amitriptyline will be for you.

Another point to consider is that the drug may have serious side effects at higher doses. These can include headaches, dizziness, and suicidal thoughts.

While there is rarely a one-size-fits-all treatment to improve any health condition, it’s certainly promising that a cheap and widely available drug has been shown to positively impact IBS symptoms in a trial.

IBS is a debilitating condition that affects many people and amitriptyline appears to be an effective and accessible way to treat it.