Dawaa Reference

chronic

Irritable bowel syndrome (IBS)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (polyethylene glycol 3350 (macrogol) monograph, ATC A06AD65) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (trimebutine monograph) · Mebeverine 50mg/5ml Sugar Free Oral Suspension SmPC section 4.2 (eMC product 14976); Colofac Tablets 135 mg SmPC section 4.2 (eMC product 102499) · Irritable Bowel Syndrome - StatPearls - NCBI Bookshelf (NBK534810)

Verified against6 documents
  • Egyptian National Drug Formulary (endf-git.txt)
  • Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph)
  • Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (polyethylene glycol 3350 (macrogol) monograph, ATC A06AD65)
  • Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (trimebutine monograph)
  • Irritable Bowel Syndrome - disease-level clinical article (irritable-bowel-syndrome-full.txt)
  • Mebeverine 50mg/5ml Sugar Free Oral Suspension SmPC section 4.2 (eMC product 14976); Colofac Tablets 135 mg SmPC section 4.2 (eMC product 102499)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (12)

  • IBS requires recurrent abdominal pain averaging at least 1 day a week over the past 3 months [abdominal pain]
  • The pain must be linked to at least 2 of: defecation, a change in how often stools occur, or a change in stool form
  • Symptom criteria must be met within the 3 months before diagnosis, with onset at least 6 months prior
  • IBS-D is defined by over 25% of abnormal bowel movements being loose/watery and under 25% hard
  • IBS-C is defined by over 25% of abnormal bowel movements being hard/lumpy and under 25% loose
  • IBS-M has more than 25% of movements in each direction - both loose and hard
  • Onset after age 50, visible or occult GI bleeding, and fever, chills or night sweats are alarm features pointing away from IBS [bleeding · chills · fever · night sweats]
  • Nocturnal diarrhea, unintentional weight loss, and a change in the patient's usual IBS pattern are also red flags [diarrhoea · weight loss]
  • Recent antibiotic use, abnormal labs, and a family history of GI cancer, IBD, or celiac disease should raise suspicion of an organic cause
  • The disordered defecation takes any of three forms: constipation, diarrhoea, or bowel habits that alternate between them [constipation · diarrhoea]
  • Bloating keeps company with it very often, but the diagnosis does not require it [abdominal distension]
  • The abdominal pain is often tied to opening the bowels, and it varies in where it sits, what it feels like and how bad it gets [abdominal pain]

Signs — what you find (2)

  • Physical exam is usually normal in IBS, though some patients have tenderness to palpation
  • Digital rectal exam checks the rectal wall for stricture, mass, or fecal impaction, and assesses the anal sphincter [stricture]

Tests (12)

  • A colonoscopy with biopsies of both the left and right colon is done to rule in or out microscopic colitis when IBS-D alarm features are present without a recent colonoscopy
  • Colorectal cancer screening should proceed as age-appropriate in every IBS patient
  • IBS-D workup includes celiac serologies, total IgA, CRP, and fecal calprotectin or lactoferrin to rule out IBD
  • A colonoscopy with left and right colon biopsies is used to confirm or exclude microscopic colitis in IBS-D
  • In areas where it's endemic, a Giardia stool antigen test is advised for IBS-D
  • Stool analysis, food-allergy testing, and hydrogen breath testing for SIBO are reserved for IBS-D cases with specific clinical suspicion, not done routinely
  • IBS-C workup includes a plain abdominal x-ray plus CRP, calcium, and TSH blood tests
  • Anorectal manometry, balloon expulsion testing, and colonic transit studies are reserved for IBS-C that is refractory to treatment or particularly severe, to look for pelvic floor dysfunction
  • Routine colonoscopy is not recommended for IBS-C patients under 45 without alarm symptoms
  • IBS-M workup checks CRP, fecal calprotectin or lactoferrin, celiac antibodies, and total IgA, plus a stool diary
  • Food sensitivity or allergy testing is limited to patients whose symptoms strongly suggest that diagnosis
  • Diagnose it positively rather than by exclusion - that gets the patient treated sooner and leaves them better off

If not this — what else fits (9)

  • A history of excessive straining or needing manual disimpaction points toward pelvic floor dysfunction rather than IBS-C itself
  • Small intestinal bacterial overgrowth is another differential for IBS-D symptoms
  • Exocrine pancreatic insufficiency is on the differential list for diarrhea-predominant IBS
  • Chronic infections such as giardiasis are on the differential for IBS-D
  • Lactose or fructose intolerance can mimic IBS-D symptoms
  • Slow colonic transit is a differential to consider for constipation-predominant IBS
  • Dyssynergic defecation is on the differential list for IBS-C
  • Endocrine causes such as hypothyroidism or high calcium should be considered for IBS-C symptoms
  • Celiac disease and IBD must be excluded in patients with diarrhea-predominant IBS symptoms

SourceStatPearls "Irritable Bowel Syndrome" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Constipation-predominant | Pain and transit | Neuromodulator for persistent abdominal pain | Diarrhoea that looks like bile acid malabsorption | Antispasmodic alternative when mebeverine is not enough | Diarrhoea-predominant IBS that has failed the other oral options

MAIN TREATMENT - choose one, plus any add-on marked below

1

MEBEVERINE

1st line

Strength135 mg

Formoral.solid

Adult dose and duration

135 mg TID 20 minutes before meals - As required for symptom flares

Paediatric dose

(No UK label carries a mebeverine dose below 10 years. The oral suspension says of children under 10, in these words, "Not applicable", and the 135 mg tablet is not recommended below 18 for insufficient safety and efficacy data. From 10 years the suspension gives 15 mL (150 mg) three times daily, 20 minutes before meals. No label supports bands of 25 mg from age 3 or 50 mg from age 8; a child under 10 with these symptoms should be assessed, not given an antispasmodic.)

Dose by age
10 years and over:15 mL of the oral suspension (150 mg) three times daily, 20 minutes before meals. No UK label carries a dose below 10 years.
Dose source

Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (mebeverine monograph): "Tablets: 100 mg, 135 mg" and "Adult dosing Immediate release forms Oral: 100-150 mg three times daily, preferably 20 minutes before meals", with "Children 10 years and above Oral suspension: 150 mg three times daily, preferably 20 minutes before meals". The Colofac 135 mg tablet SmPC is not held in this corpus.

Why

Direct smooth-muscle relaxant without anticholinergic side effects

Cautions
  • Take 20 minutes before meals for optimal antispasmodic efficacy.
  • Avoid in paralytic ileus.
  • Hypersensitivity reactions (urticaria, angioedema) are reported rarely.
  • The tablet is 135 mg and the suspension doses at 150 mg. They are not the same figure and the tablet is adults-only, so do not read the tablet strength across to a child.
Egyptian brands
Egyptian brandManufacturerIndicative price
SPASMOTALIN FORTE 135MG 20 F.C. TABS.AMRIYA12.50 EGP (0.62/unit)
COLORELAX 135MG 20 F.C.TAB.HI-PHARM14.40 EGP (0.72/unit)
COLOVERIN 135 MG 30 TABS.CHEMIPHARM78.00 EGP (2.60/unit)
COLOSPATORAZ 135MG 30 TABS.ORGANOPHARMA > NALI PHARMA INTERNATIONAL81.00 EGP (2.70/unit)
MEPACOLON 135MG 20 F.C.TAB.MEPACO54.00 EGP (2.70/unit)
KOLOCUREJED 135 MG 20 C. TAB.JEDCO INT. CO. FOR PHARMACEUTICALS12.50 EGP
COLOSPASMIN FORTE 135 MG 20 SUGAR C.TABS.EIPICO51.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Irritable Bowel Syndrome - disease-level clinical article (irritable-bowel-syndrome-full.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Look for alarm features and red flags for underlying organic gastrointestinal disease.
3

MACROGOL 3350

2nd line

Formoral.liquid

Adult dose and duration

1-3 sachets daily in divided doses, adjusted up or down as required to produce regular soft stools (maximum 4 sachets a day) - the 13.125 g adult sachet

Paediatric dose

(Child 2-6 yrs: starting dose 1 sachet daily; Child 7-11 yrs: 2 sachets daily - the 6.563 g paediatric sachet, not the adult one. Adjust to produce regular soft stools.)

Dose by age
2 to 6 years:1 sachet daily to start - the 6.563 g paediatric sachet, not the adult one
7 to 11 years:2 sachets daily - the 6.563 g paediatric sachet, not the adult one
Dose source

Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (polyethylene glycol 3350 (macrogol) monograph, ATC A06AD65)

Why

Osmotic laxative for the constipation limb of IBS (IBS-C). Dosed here in the Egyptian sachet the register actually carries, on the ENDF's adult indication - the same figures as the constipation card.

Cautions
  • Not recommended in children under 2 years of age for chronic constipation.
  • Ensure adequate hydration during treatment.
  • The sachet sizes are not interchangeable, and the doses above are counted in sachets. ENDF verbatim: "Products containing 6.563 grams per sachet: 1. For the treatment of chronic constipation in children 2 to 11 years of age" and "Products containing 13.125 grams per sachet: 4. Treatment of chronic constipation in adults". MOVICOL PAEDIATRIC is the 6.563 g sachet; MOVICOL is the 13.125 g one.
  • NOT the colonoscopy preparation, which is the same drug at eight times the pouch. MOVIPREP and PREPAWEST are that product and are deliberately not listed below.
  • For the constipation limb of IBS only. It does not treat the pain or the diarrhoea limb, and an osmotic laxative can worsen bloating in IBS.
Egyptian brands
Egyptian brandManufacturerIndicative price
MOVICOL PAEDIATRIC 30 SACHETS! also contains potassium chloride, sodium chloride, sodium hydrogen carbonateNORGINE LIMITED > ACINO221.00 EGP
MOVICOL 20 SACHETS! also contains potassium chloride, sodium bicarbonate, sodium chlorideNORGINE LIMITED > ACINO273.00 EGP
4

LOPERAMIDE

add-on - not a substitute

Strength2 mg

Formoral.solid

Adult dose and duration

Initial dose: 4 mg, followed by 2 mg after each loose stool. - As needed for diarrhea flares

Paediatric dose

Adolescents 12 to 18 years (acute diarrhea): 2 to 4 mg initially, then 2 mg after each loose stool; max 8 to 16 mg/day. Children 6 to 12 years: 6-8 yr (20-30 kg): 2 mg twice daily; 8-12 yr (>30 kg): 2 mg three times daily; subsequent: 1 mg per 10 kg after each loose stool. Contraindicated in children <2 years. IBS diarrhoea indication is adults >=18 years only.

Dose source

Egyptian National Drug Formulary (endf-git.txt)

Why

Synthetic opioid agonist used for symptomatic control of diarrhea episodes in diarrhea-predominant IBS.

Cautions
  • Avoid use in higher than recommended doses due to risk of serious cardiac adverse reactions (QT prolongation, Torsades de Pointes).
  • Discontinue immediately if constipation, abdominal distention, or ileus develops.
Egyptian brands
Egyptian brandManufacturerIndicative price
MOTIJUST 2 MG 30 CAPSINTERNATIONAL DRUG INDUSTRIES > NOVELL PHARMA27.00 EGP (0.90/unit)
STOPRRHEA 2 MG 10 ORODISPERSIBLE TABS.WESTERN PHARMACEUTICALS INDUSTRIES > WESTERN PHARMA10.00 EGP
IMODIUM INSTANT 2MG 6 ORODISPERSIBLE TABS.MCNEIL PRODUCTS LTD. > JOHNSON & JOHNSON SCIENTIFIC OFFICE80.00 EGP
STOPRRHEA 2 MG 30 ORODISPERSIBLE TABS.WESTERN PHARMACEUTICALS INDUSTRIES > WESTERN PHARMA96.00 EGP

CONSTIPATION-PREDOMINANT

5

LACTULOSE

Constipation-predominant

2nd line

Formoral.liquid

Adult dose and duration

15-30 mL daily in 1-2 divided doses for constipation-predominant IBS - As needed

Paediatric dose

(Infant under 1 year: up to 5 mL daily. Child 1-6 years: 5-10 mL daily. Child 7-14 years: start 15 mL daily, maintenance 10-15 mL daily. Adjust to produce a soft stool without diarrhoea.)

Dose by age
Under 1 year:Up to 5 mL daily
1 to 6 years:5 to 10 mL daily
7 to 14 years:15 mL daily to start, then 10 to 15 mL daily. Adjust to produce a soft stool without diarrhoea.
Dose source

Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph)

Why

NICE CG61 discourages lactulose in IBS due to gas and bloating, but it remains utilized in local Egyptian practice as an alternative osmotic laxative.

Cautions
  • May cause flatulence, abdominal cramps, and bloating initially.
  • Ensure adequate fluid intake.
  • Takes 24-48 hours to produce laxative effect.
Egyptian brands
Egyptian brandManufacturerIndicative price
FARCOLAC 667GM/L SYRUP 120 MLPHARCO7.50 EGP
LACTOLINE 50% SYRUP 200MLALEXANDRIA9.25 EGP
LAEVOLAC 67GM/100ML SYRUP 120 MLSIGMA > FRESENIUS KABI12.00 EGP
SEDALAC 3.35GM/5ML SYRUP 120MLSEDICO20.00 EGP
LAXOLAC 3.35GM/5ML SYRUP 300MLMUP40.00 EGP
LAXOLAC 3.35GM/5ML SYRUP 120MLMUP50.00 EGP
DUPHALAC 667GM/L SYRUP 200MLABBOTT LABORATORIES143.00 EGP
LACTULOSE-AUG PHARMA 3.35GM/5ML SYRUP 320MLAUG PHARMA170.00 EGP
VILLAPURG 67% SYRUP 120 ML? strength differs? different route - not oral liquidAL ESRAA PHARMACEUTICAL OPTIMA12.00 EGP
VILLAPURG 67% SYRUP 200 ML? strength differs? different route - not oral liquidAL ESRAA PHARMACEUTICAL OPTIMA17.75 EGP

PAIN AND TRANSIT

6

TRIMEBUTINE

Pain and transit

2nd line

Strength100 mg

Formoral.solid

Adult dose and duration

100 mg every 8 hours taken before meals; may be increased to a maximum of 200 mg every 8 hours - Symptomatic; review benefit at 4 weeks and stop if there is none

Paediatric dose

(The formulary gives dosing only for 12 years and over (adult dose). Contraindicated under 2 years. Oral suspension 24 mg/5 mL exists for children but the monograph states no dose for the 2-11 year band.)

Dose by age
12 years and over:The adult dose. Contraindicated under 2 years, and no dose is stated for 2 to 11 years.
Dose source

Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (trimebutine monograph)

Why

14 live products and a formulary indication that maps directly onto IBS - 'pain, transit disorders and intestinal discomfort associated with functional intestinal disorders'. Unlike mebeverine it acts on both constipation- and diarrhoea-predominant transit.

Cautions
  • Symptomatic only - it does not alter the course of IBS, and diet, fibre and sleep advice do more.
  • The evidence base is weaker than for mebeverine; treat it as an alternative when mebeverine has failed or is not tolerated.
  • Contraindicated under 2 years of age.
  • Review the diagnosis rather than repeating the prescription if there is weight loss, nocturnal symptoms, rectal bleeding, or onset over age 50.
Egyptian brands
Egyptian brandManufacturerIndicative price
TRIBUDAT 100MG 20 TAB.SIGMA12.00 EGP (0.60/unit)
GAST-REG 100 MG 30 TABS.AMOUN72.00 EGP (2.40/unit)
PRONTOMUTIM 100 MG 30 F.C. TABS.MEDIZEN PHARMACEUTICAL INDUSTRIES72.00 EGP (2.40/unit)
TRITONE 100MG 30 TAB.GLOBAL NAPI PHARMACEUTICALS72.00 EGP (2.40/unit)
GAST-REG 24MG/5ML 125ML SUSP.? strength differs? different route - not oral solidAMOUN33.00 EGP
TRITONE 4.8MG/ML SUSP. 125ML? strength differs? different route - not oral solidGLOBAL NAPI PHARMACEUTICALS33.00 EGP

NEUROMODULATOR FOR PERSISTENT ABDOMINAL PAIN

7

AMITRIPTYLINE

Neuromodulator for persistent abdominal pain

2nd line

Strength10 mg

Formoral.solid

Adult dose and duration

10 mg at night, raised slowly if needed to 30 mg a day

Paediatric dose

No paediatric dose in the sources opened.

Dose source

Irritable Bowel Syndrome - StatPearls - NCBI Bookshelf (NBK534810)

Why

The card treats spasm and transit but has nothing for the persistent pain that brings most IBS patients back. A low-dose tricyclic works on gut pain signalling rather than mood, and its slowing effect on the bowel suits the diarrhoea-predominant patient. Move the dose up over weeks, not days.

Cautions
  • Warn the patient about drowsiness, dry mouth and constipation, and give the dose at night.
  • Avoid it in someone with glaucoma, urinary retention, a recent heart attack or a known heart rhythm problem.
  • This is a pain dose, not an antidepressant dose - say so, or the patient may stop the tablet when they read the leaflet.
Egyptian brands
Egyptian brandManufacturerIndicative price
TRYPTIZOL 10 MG 20 TABS.KAHIRA10.00 EGP (0.50/unit)
TRYPTIZOL 10 MG 60 TABS.KAHIRA30.00 EGP (0.50/unit)
GRANITYLLIN 25MG/5ML SYP. 120 ML? strength differs? different route - not oral solidGRAND PHARMA > DELTA GRAND PHARMA5.00 EGP
ZINOTRAVAL 25MG/5ML SYP. 120 ML? strength differs? different route - not oral solidDEBEIKY > PHARMACHEMIC10.00 EGP

DIARRHOEA THAT LOOKS LIKE BILE ACID MALABSORPTION

8

CHOLESTYRAMINE

Diarrhoea that looks like bile acid malabsorption

2nd line

Formoral.liquid

Adult dose and duration

2 to 4 g a day, as one dose or split into two

Paediatric dose

No paediatric dose in the sources opened.

Dose source

Irritable Bowel Syndrome - StatPearls - NCBI Bookshelf (NBK534810)

Why

Bile acid malabsorption sits behind a large share of diarrhoea-predominant IBS and does not respond to antispasmodics. A bile acid sequestrant is the specific answer, and it is a cheap sachet in Egypt. Worth a trial in the patient whose stool is watery and urgent, especially after meals.

Cautions
  • It binds other drugs in the gut - separate every other tablet from it by several hours, and check this against anything the patient takes for the heart or the thyroid.
  • Long use can interfere with the absorption of fat-soluble vitamins.
  • It commonly causes bloating and constipation, which can be mistaken for the IBS getting worse.
Egyptian brands
Egyptian brandManufacturerIndicative price
CHOLESTRAN 4 GM 12 SACHETSPHARCO19.80 EGP
QUANTAMASH 4 GM 12 SACHETSDEBEIKY > MASH PREMIERE83.00 EGP
QUESTRAN 4 GM 50 SACHETS (ILLEGAL IMPORT)BRISTOL-MYERS SQUIBB54.00 EGP

ANTISPASMODIC ALTERNATIVE WHEN MEBEVERINE IS NOT ENOUGH

9

PEPPERMINT OIL

Antispasmodic alternative when mebeverine is not enough

2nd line

Formoral.solid

Adult dose and duration

180 to 360 mg (0.2 to 0.4 mL) three times a day, as an enteric-coated capsule

Paediatric dose

No paediatric dose in the sources opened.

Dose source

Irritable Bowel Syndrome - StatPearls - NCBI Bookshelf (NBK534810)

Why

It relaxes intestinal smooth muscle by a different route from mebeverine, so it is a real second try rather than a repeat of the first. It is sold over the counter in Egypt for a few pounds, which matters for a condition the patient will be managing for years.

Cautions
  • The capsule must be enteric-coated and swallowed whole; if the oil is released in the stomach it causes heartburn instead of relief.
  • Confirm with the pharmacist that the box is a plain peppermint oil capsule - most Egyptian mint products are multi-herb digestive mixtures or massage rubs.
  • Avoid it in a patient whose main complaint is reflux, because it relaxes the valve at the top of the stomach.
Egyptian brands
Egyptian brandManufacturerIndicative price
COLOMINT 24 CAPS.PHARCO5.50 EGP (0.23/unit)

DIARRHOEA-PREDOMINANT IBS THAT HAS FAILED THE OTHER ORAL OPTIONS

10

RIFAXIMIN

Diarrhoea-predominant IBS that has failed the other oral options

2nd line

Strength550 mg

Formoral.solid

Adult dose and duration

550 mg three times a day x 14 days

Paediatric dose

No paediatric dose in the sources opened.

Dose source

Irritable Bowel Syndrome - StatPearls - NCBI Bookshelf (NBK534810)

Why

A gut-only antibiotic that acts on the bacterial overgrowth behind some diarrhoea-predominant IBS. It sits after the antispasmodic, the peppermint oil and the tricyclic, not before them. If the first course works, it may be repeated every three to four months rather than taken continuously.

Cautions
  • It is by far the most expensive of the options listed - price the full course before writing it.
  • Do not use it as a first move for IBS diarrhoea; it belongs after the cheaper options have genuinely been tried.
  • Stop it and reconsider the diagnosis if diarrhoea becomes severe or bloody during or after the course.
Egyptian brands
Egyptian brandManufacturerIndicative price
IDIBACT 550 MG 20 F.C.TAB.INTERNATIONAL DRUG INDUSTRIES > NOVELL PHARMA103.75 EGP (5.19/unit)
ROLAXIMINE 550 MG 30 F.C. TAB.EVA PHARMA > HORUS FOR PHARMACEUTICAL PRODUCTS225.00 EGP (7.50/unit)
RIFAXEROSE 550 MG 10 F.C. TABS.AVERROES PHARMA82.00 EGP (8.20/unit)
BIOREFAMIN 550 MG 10 F.C.TABS.P & C LABS > SOVALUE PHARMA148.00 EGP (14.80/unit)
DUFAXIMIN 550 MG 28 F.C. TABS.AUG PHARMA480.00 EGP (17.14/unit)
FATROXIM 550 MG 30 F.C. TAB.EGPI > ATM PHARMACEUTICAL INDUSTRIES516.00 EGP (17.20/unit)
GASTROBIOTIC 550 MG 30 F.C. TAB.ANDALOUS PHARMA516.00 EGP (17.20/unit)
TRAVIGUARD 550 MG 20 F.C. TABS.P AND C LABS > TREND PHARM344.00 EGP (17.20/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.