"The best I've felt in over 30 years!!!"

The situation: I recently learned from a patient, Betsy, that she has been constipated since age 16, now in her fifties. Because of a drug interaction, I had occasion to speak with her over the past few weeks regarding her condition. In a nutshell, she has been diagnosed with constipation-predominant irritable bowel syndrome (IBS-C). The spasms have been barely controlled with anti-spasmodics like dicyclomine and Hyomax, however they contribute to the constipation, which contributes to the spasms, especially when she eats, and results in numerous clinic, urgent care, and ER visits. Upon further investigation, another part of the problem was that she was taking her 'as needed' anti-spasmodic medicines all the time. This was causing serious difficulty swallowing her food and medicines, because even normal peristaltic spasms that move food along in the gut in her esophagus were inhibited--two hours for a capsule 'to go down' is not good.

The intervention: She has learned she only needs to take her anti-spasmodics as needed (as prescribed). She is also taking acetaminophen liquid instead of aspirin for pain relief. Plus, after research into therapeutic alternatives and her insurance formulary, and sending a request to her prescriber, her doctor added Amitiza (generic lubiprostone) to her regimen. Amitiza is a prostaglandin that basically adds lubrication to the gut and has very few side effects (nausea and headache are most common). When I told Betsy about it, she was eager to try it. The cost was under $10/month with her insurance, which was nothing compared to the costs of all the other things she has tried, both prescription and non-prescription.

The results: She reported two weeks later, that although she still has had some spasms, one recently sent her to the ER again, they seem to be lessening, she told me that it has been 30 years since she has "felt normal like this," in terms of her constipation. Now that's why I became a pharmacist :)