Diagnosis and Management of Diarrhea-Predominant Irritable Bowel Syndrome: Clinical Overview of Alosetron

Abstract

Background:Irritable bowel syndrome (IBS) is a functional bowel disorder associated with considerable impairment in quality of life and utilization of healthcare resources. Owing to the high incidence and chronicity of the disorder, nurse practitioners (NPs) and physician assistants (PAs) likely encounter IBS patients in their practices. Recent updates in the Risk Evaluation and Mitigation Strategy (REMS) for alosetronhave allowed NPs and PAs to enroll in the program to prescribe this selective 5-HT3 receptor antagonist used to treat IBSfor patients with severe diarrhea-predominant IBS (IBS-D).Aim: To provide an overview of the diagnostic process and current treatment options for IBS, with specific focus on the efficacy, safety, tolerability, and prescribing requirements for alosetron. Methods: The supporting evidence for the labeled efficacy and safety of alosetron in the management of IBS-D was assessed.Results:Whereas conventional therapies provide benefit for a specific symptom of IBS, alosetronhas been shown to provide multisymptom relief in IBS-D, including improvements in abdominal pain, stool consistency, stool frequency, bowel urgency, and IBS-related quality of life. Analysis of postmarketing safety data captured since the alosetronrisk management program was initiated in 2002 suggests that serious outcomes associated with ischemic colitis and serious complications of constipation have been mitigated.Conclusions:Alosetronprovides a favorable risk-to-benefit profile for women with severe IBS-D who have not responded to treatment with conventional agents. By acquiring evidence-based treatment knowledge related to IBS, NPs and PAs may ultimately improve the overall management of this complicated, and relatively common, condition.