Predominant symptom	Medications	Dosage	AFP level of evidence	Comment
Diarrhea	Loperamide (Imodium)	2 to 4 mg up to four times a day	Level A	Use as needed or prophylactically in times of anticipated stress
	Cholestyramine (Questran)	4 g one to six times a day	Level C	Second-line agent
	Alosetron (Lotronex)	1 mg per day titrated to two times a day if tolerated	Level A	Restricted use in female patients only
Constipation	Fiber	Start low and titrate up to 20 to 30 g a day	Level A	May worsen bloating
	Osmotic laxative	Magnesium citrate, lactulose, or polyethylene glycol dosed as appropriate	Level C
Abdominal pain	Antispasmodics and anticholinergics (e.g., dicyclomine [Bentyl], hyoscyamine [Levsin])	Dicyclomine, 10 to 20 mg, two to four times a day	Level B	Used as needed only
	Tricyclic antidepressant (e.g., amitriptyline [Elavil])	Start amitriptyline, 10 to 25 mg at bedtime or twice daily, or desipramine (Norpramin), 50 mg three times a day	Level A	Needs to be given daily, not as needed, therefore generally reserved for patients with more severe pain
	Tegaserod (Zelnorm)			FDA approved for short-term treatment of women
Gas or bloating	Simethicone (Mylanta)	40 to 125 mg up to four times a day as needed		Anecdotal evidence only
Comorbid depression or anxiety	Antidepressants or anxiolytics as indicated	Dose as appropriate		Treating depression has been shown to improve bowel symptoms15