# Irritable bowel syndrome (IBS) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Mebeverine — 135 mg — oral.solid - Referral & safety-netting (no drug therapy) - Lactulose — oral.liquid - Trimebutine — 100 mg — oral.solid - Macrogol 3350 — oral.liquid - Amitriptyline — 10 mg — oral.solid - Cholestyramine — oral.liquid - Peppermint oil — oral.solid - Rifaximin — 550 mg — oral.solid - Loperamide — 2 mg — oral.solid ## Complete treatment card ```text IRRITABLE BOWEL SYNDROME (IBS) 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) Review status: REVIEWED against 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) (2026-08) 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 Source StatPearls "Irritable Bowel Syndrome" - disease-level clinical article Status 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] Adult 135 mg TID 20 minutes before meals - As required for symptom flares Peds 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. (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.) 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 Caution 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. Egypt SPASMOTALIN FORTE 135MG 20 F.C. TABS. AMRIYA 12.50 EGP (0.62/unit) COLORELAX 135MG 20 F.C.TAB. HI-PHARM 14.40 EGP (0.72/unit) COLOVERIN 135 MG 30 TABS. CHEMIPHARM 78.00 EGP (2.60/unit) COLOSPATORAZ 135MG 30 TABS. ORGANOPHARMA ... 81.00 EGP (2.70/unit) MEPACOLON 135MG 20 F.C.TAB. MEPACO 54.00 EGP (2.70/unit) KOLOCUREJED 135 MG 20 C. TAB. JEDCO INT. CO... 12.50 EGP COLOSPASMIN FORTE 135 MG 20 SUGAR C.TABS. EIPICO 51.00 EGP 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution RED FLAG - Look for alarm features and red flags for underlying organic gastrointestinal disease. 3. MACROGOL 3350 [2nd line] Adult 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 Peds 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 (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.) 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. Caution 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. Egypt MOVICOL PAEDIATRIC 30 SACHETS NORGINE LIMIT... 221.00 EGP -> ! also contains potassium chloride, sodium chloride, sodium hydrogen carbonate MOVICOL 20 SACHETS NORGINE LIMIT... 273.00 EGP -> ! also contains potassium chloride, sodium bicarbonate, sodium chloride 4. LOPERAMIDE [add-on - not a substitute] Adult Initial dose: 4 mg, followed by 2 mg after each loose stool. - As needed for diarrhea flares Peds 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. Source Egyptian National Drug Formulary (endf-git.txt) Why Synthetic opioid agonist used for symptomatic control of diarrhea episodes in diarrhea- predominant IBS. Caution 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. Egypt MOTIJUST 2 MG 30 CAPS INTERNATIONAL... 27.00 EGP (0.90/unit) STOPRRHEA 2 MG 10 ORODISPERSIBLE TABS. WESTERN PHARMACEUTICALS INDUSTRIE... 10.00 EGP IMODIUM INSTANT 2MG 6 ORODISPERSIBLE TABS. MCNEIL PRODUCTS LTD. > JOHNSO... 80.00 EGP STOPRRHEA 2 MG 30 ORODISPERSIBLE TABS. WESTERN PHARMACEUTICALS INDUSTRIE... 96.00 EGP CONSTIPATION-PREDOMINANT 5. LACTULOSE [2nd line] Adult 15-30 mL daily in 1-2 divided doses for constipation-predominant IBS - As needed Peds 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. (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.) 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. Caution May cause flatulence, abdominal cramps, and bloating initially. Ensure adequate fluid intake. Takes 24-48 hours to produce laxative effect. Egypt FARCOLAC 667GM/L SYRUP 120 ML PHARCO 7.50 EGP LACTOLINE 50% SYRUP 200ML ALEXANDRIA 9.25 EGP LAEVOLAC 67GM/100ML SYRUP 120 ML SIGMA > FRESE... 12.00 EGP SEDALAC 3.35GM/5ML SYRUP 120ML SEDICO 20.00 EGP LAXOLAC 3.35GM/5ML SYRUP 300ML MUP 40.00 EGP LAXOLAC 3.35GM/5ML SYRUP 120ML MUP 50.00 EGP DUPHALAC 667GM/L SYRUP 200ML ABBOTT LABORA... 143.00 EGP LACTULOSE-AUG PHARMA 3.35GM/5ML SYRUP 320ML AUG PHARMA 170.00 EGP VILLAPURG 67% SYRUP 120 ML AL ESRAA PHAR... 12.00 EGP -> ? strength differs, ? different route - not oral liquid VILLAPURG 67% SYRUP 200 ML AL ESRAA PHAR... 17.75 EGP -> ? strength differs, ? different route - not oral liquid PAIN AND TRANSIT 6. TRIMEBUTINE [2nd line] Adult 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 Peds 12 years and over: The adult dose. Contraindicated under 2 years, and no dose is stated for 2 to 11 years. (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.) 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. Caution 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. Egypt TRIBUDAT 100MG 20 TAB. SIGMA 12.00 EGP (0.60/unit) GAST-REG 100 MG 30 TABS. AMOUN 72.00 EGP (2.40/unit) PRONTOMUTIM 100 MG 30 F.C. TABS. MEDIZEN PHARM... 72.00 EGP (2.40/unit) TRITONE 100MG 30 TAB. GLOBAL NAPI P... 72.00 EGP (2.40/unit) GAST-REG 24MG/5ML 125ML SUSP. AMOUN 33.00 EGP -> ? strength differs, ? different route - not oral solid TRITONE 4.8MG/ML SUSP. 125ML GLOBAL NAPI P... 33.00 EGP -> ? strength differs, ? different route - not oral solid NEUROMODULATOR FOR PERSISTENT ABDOMINAL PAIN 7. AMITRIPTYLINE [2nd line] Adult 10 mg at night, raised slowly if needed to 30 mg a day Peds No paediatric dose in the sources opened. 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. Caution 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. Egypt TRYPTIZOL 10 MG 20 TABS. KAHIRA 10.00 EGP (0.50/unit) TRYPTIZOL 10 MG 60 TABS. KAHIRA 30.00 EGP (0.50/unit) GRANITYLLIN 25MG/5ML SYP. 120 ML GRAND PHARMA ... 5.00 EGP -> ? strength differs, ? different route - not oral solid ZINOTRAVAL 25MG/5ML SYP. 120 ML DEBEIKY > PHA... 10.00 EGP -> ? strength differs, ? different route - not oral solid DIARRHOEA THAT LOOKS LIKE BILE ACID MALABSORPTION 8. CHOLESTYRAMINE [2nd line] Adult 2 to 4 g a day, as one dose or split into two Peds No paediatric dose in the sources opened. 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. Caution 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. Egypt CHOLESTRAN 4 GM 12 SACHETS PHARCO 19.80 EGP QUANTAMASH 4 GM 12 SACHETS DEBEIKY > MAS... 83.00 EGP QUESTRAN 4 GM 50 SACHETS (ILLEGAL IMPORT) BRISTOL-MYERS SQUIBB 54.00 EGP ANTISPASMODIC ALTERNATIVE WHEN MEBEVERINE IS NOT ENOUGH 9. PEPPERMINT OIL [2nd line] Adult 180 to 360 mg (0.2 to 0.4 mL) three times a day, as an enteric-coated capsule Peds No paediatric dose in the sources opened. 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. Caution 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. Egypt COLOMINT 24 CAPS. PHARCO 5.50 EGP (0.23/unit) DIARRHOEA-PREDOMINANT IBS THAT HAS FAILED THE OTHER ORAL OPTIONS 10. RIFAXIMIN [2nd line] Adult 550 mg three times a day x 14 days Peds No paediatric dose in the sources opened. 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. Caution 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. Egypt IDIBACT 550 MG 20 F.C.TAB. INTERNATIONAL... 103.75 EGP (5.19/unit) ROLAXIMINE 550 MG 30 F.C. TAB. EVA PHARMA > ... 225.00 EGP (7.50/unit) RIFAXEROSE 550 MG 10 F.C. TABS. AVERROES PHARMA 82.00 EGP (8.20/unit) BIOREFAMIN 550 MG 10 F.C.TABS. P & C LABS > ... 148.00 EGP (14.80/unit) DUFAXIMIN 550 MG 28 F.C. TABS. AUG PHARMA 480.00 EGP (17.14/unit) FATROXIM 550 MG 30 F.C. TAB. EGPI > ATM PH... 516.00 EGP (17.20/unit) GASTROBIOTIC 550 MG 30 F.C. TAB. ANDALOUS PHARMA 516.00 EGP (17.20/unit) TRAVIGUARD 550 MG 20 F.C. TABS. P AND C LABS ... 344.00 EGP (17.20/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)