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Does my child need to continue her medicines for IBS?

Q: My 18-year-old daughter developed a lot of gastric problems over the last two years. We consulted a gastroenterologist who diagnosed her problem as irritable bowel syndrome (IBS). He prescribed Nexito 5 mg, Sarotena 5 mg and Folvite 10 mg per day. She is taking these medicines for the last 1.5 years. Two months back we consulted the doctor again and he advised her to continue the medicines though she is fine now. Should she be continuing the medicines? If yes, then for how long? Will she get addicted to these medicines?

A:The treatment of correctly diagnosed IBS case involves many therapies such as counselling, diet, stool bulking agents, antispasmodics, antidiarrhoeal (if required), antiflatulent agents, drugs (alosetron, tegaserod, and antidepressants), etc. Unfortunately, there is no objective test to diagnose IBS; hence, the diagnosis is clinical and exclusively based on signs and symptoms alone. Nexito is the brand name; the name of the medicine is escitalopram. Sarotena contains amitriptyline. Both these drugs are basically used in the treatment of major depression, but they are also used in IBS. The use of Sarotena, which is an old tried-and-tested molecule, is quite common and relatively safe. However, Nexito is uncommonly used and that too if one drug (Sarotena) is ineffective. In any event, the use of two anti-psychotic drugs concurrently would be needed in a very few cases of IBS. When used for depression, the side effects of Nexito are: Development of suicidal tendency; severe agitation-type events including agitation, disinhibition, emotional lability, hostility, aggression and depersonalisation. For ethical reasons, no clinical trials have been undertaken to determine if the same side effects will occur when administered to patients of other diseases. However, generally, the side effects of medicines are uniform irrespective of indications for which they are used. Under the circumstances, it would be prudent to gradually withdraw Nexito by reducing the dose. Apart from its known and unknown adverse effects, the drug interacts with large number of other medicines, and hence caution should be exercised. Once this is done, an attempt can be made to see if Sarotena can also be withdrawn.

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