II. Indications
- Diarrhea Predominant Irritable Bowel Syndrome
III. Contraindications
- Prior Cholecystectomy
- Pancreatitis risk
- Sphincter of Odi dysfunction
- Biliary duct obstruction
- Alcohol use >3 drinks/day or Alcoholism
- Severe Constipation history
- Small Bowel Obstruction history
- Severe Liver Disease (Child Pugh Class C)
IV. Mechanism
- DEA Class IV controlled substance in U.S.
- Mu-opioid Agonist
- Similar activity to Loperamide
V. Dosing
- Standard dose
- Take 100 mg orally twice daily
- Lower dose
- Take 75 mg orally twice daily
- Indications for lower dose
- Intolerant of standard dose
- Liver dysfunction
- eGFR <60 ml/min
- Elderly
- OATP1B1 Inhibitor use (see Drug Interactions below)
VI. Adverse Effects
- Common
- Abdominal Pain
- Nausea
- Constipation
- Hold Eluxadoline for severe Constipation
- Uncommon but serious (deaths have occurred)
VII. Safety
- Pregnancy Category C
- Unknown safety in Lactation
VIII. Efficacy
- More effective at reducing loose stools than in reducing Abdominal Pain
- Marginal efficacy (NNT 11) for decreased Diarrhea and Abdominal Pain at 6 months
IX. Drug Interactions
- Concurrent medications predisposing to Constipation
- OATP1B1 Inhibitors
-
Rosuvastatin
- Eluxadoline may increase Rosuvastatin levels (risk of Statin Myopathy)
X. Resources
XI. References
- (2016) Presc Lett 23(6):32
- (2017) Presc Lett 24(5):27
- (2021) Irritable Bowel Syndrome Drug Comparison, Presc Lett, #370305
- (2020) Med Lett Drugs Ther 62(1594): 41-58
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