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By the way, doctor: Is Zelnorm safe?

By the way, doctor

Is Zelnorm safe?

Q. I have irritable bowel syndrome, with frequent bloating and constipation. My doctor prescribed a six-week course of Zelnorm, which really helped. Is it safe to take long-term?

A. Zelnorm (tegaserod maleate) is a prescription medication for the short-term treatment of women with irritable bowel syndrome (IBS) whose primary symptom is constipation. Zelnorm speeds the movement of stool through the bowels, reducing pain caused by bloating and constipation.

Side effects include sleepiness, dizziness, headache, and diarrhea. A few patients have had diarrhea severe enough to require hospitalization. A very small number developed a dangerous condition called ischemic colitis, meaning lack of blood supply to the intestine.

As of early 2005, Zelnorm’s long-term safety is not known. It’s FDA-approved for 4–6 weeks; if it helps, it can be continued for another 4–6 weeks. One trial suggested that Zelnorm was generally safe, although almost half of the subjects dropped out because of side effects. Zelnorm is not for women who have ever had an obstructed bowel or who have diarrhea-predominant IBS, gallbladder, liver, or kidney problems.

IBS symptoms can be debilitating, but try to avoid the long-term use of IBS drugs if you can, because all drugs have side effects. As with any chronic health problem, managing IBS begins with understanding the condition and having a good relationship with your doctor. Lifestyle changes, such as avoiding certain foods, using fiber supplements, and exercising are also important.

So far, Zelnorm has not been compared with less expensive established treatments, such as fiber or drugs that reduce intestinal spasm, so we don’t know if it’s any better. Also, a short course of Zelnorm may not have a lasting impact on IBS. In one study, symptoms returned in about half the patients within eight weeks of stopping the drug. It’s great that Zelnorm has helped you over a rough patch. But it’s not a good choice as the main treatment for a condition as chronic as IBS.

— Celeste Robb-Nicholson, M.D. Editor in Chief, HWHW

Last updated:	August 21, 2006