Is it safe to take Eluxadoline for a long time for IBSD?

Question

Hello doctor,

I am 29 and have been dealing with loose stools almost daily for the past eight months, mostly in the mornings with urgency.

The gastroenterologist said it’s IBS-D after a normal colonoscopy and stool tests. I was given Viberzi, which helps sometimes, but symptoms return when I miss doses.

My calprotectin was normal, but anxiety seems to trigger flares. Does IBS-D really worsen with stress, or is something being missed?
Should I follow a strict low FODMAP diet long term?
Also, is it safe to take Viberzi continuously, or can it cause dependency or liver problems?

Please suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your symptoms fit well with irritable bowel syndrome with diarrhea predominance (IBS-D). The fact that your colonoscopy, stool tests, and fecal calprotectin are normal strongly supports this diagnosis and makes inflammatory bowel disease unlikely.

Yes, stress and anxiety can significantly worsen IBS symptoms. The intestines and brain communicate through the gut-brain axis, so emotional stress can increase gut sensitivity and speed up bowel movements, leading to urgency and loose stools. This does not mean something is being missed; it is a well-recognized feature of IBS.

Regarding diet, a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet can help reduce gas, bloating, and diarrhea.

However, it is usually recommended as a short-term elimination (four to six weeks) followed by gradual reintroduction of foods to identify triggers, rather than staying strictly restricted long-term.

You mentioned using Eluxadoline (Viberzi). This medication helps reduce bowel contractions and improve diarrhea in IBS-D. It does not cause dependence, and many patients take it regularly for symptom control.

However, it should be used under medical supervision because rare side effects include pancreatitis or liver-related issues, particularly in patients without a gallbladder or with liver disease.

Along with medication, helpful strategies include stress management (CBT (cognitive behavioral therapy), relaxation, or mindfulness), probiotics, regular meals, and limiting caffeine and high-fat foods.

If symptoms change significantly, such as weight loss, blood in stool, or nighttime diarrhea, your gastroenterologist should reassess the diagnosis.

I hope this helps.

For more queries, feel free to reach out to me anytime.

Thank you.