Viberzi (Eluxadoline) - Oral

What Is Viberzi?

Viberzi (eluxadoline) is a prescription medication used to treat irritable bowel syndrome (IBS) with diarrhea (diarrhea-predominant IBS, or IBS-D) in adults. It belongs to a class of drugs known as mu-opioid receptor agonists.

Viberzi works by stimulating or inhibiting various opioid receptors in the gut. It activates the mu-opioid receptors and kappa-opioid receptors and blocks the delta-opioid receptors. These receptors affect muscle movements, secretions, and sensations in the digestive tract. Viberzi's activity leads to reduced nerve sensitivity in the intestine and slows the movement of food through the colon.

Viberzi is classified as a schedule IV controlled substance, meaning it is regulated under federal law because of its potential for abuse and misuse.

What Is Viberzi Used For?

The Food and Drug Administration (FDA) approved Viberzi to treat irritable bowel syndrome with diarrhea (IBS-D) in adults.

IBS-D is a subtype that causes frequent diarrhea with abdominal (stomach) pain. It is characterized as having more than a quarter of stools that are loose or watery and less than a quarter of stools that are hard or lump on days when you have at least one abnormal bowel movement.

Viberzi can provide relief to people with IBS-D who do not respond to other anti-diarrheal medications.

How to Take Viberzi

Viberzi is available as an oral tablet, which you will take by mouth. It's important to take the medication as prescribed, usually one tablet twice a day. Take each tablet with food.

Try to limit your alcohol intake while you're taking Viberzi. Drinking more than three alcoholic beverages per day while on this medication can put you at a higher risk of acute pancreatitis (inflammation of the pancreas).

Storage

Keep Viberzi tablets stored at room temperature (68 degrees to 77 degrees Fahrenheit).

What Are the Side Effects of Viberzi?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

The most common side effects with Viberzi include:

• Constipation
• Nausea
• Abdominal pain
• Upper respiratory infection

Talk to your healthcare provider if these side effects don’t go away or become more severe.

Severe Side Effects

Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects can include:

• Severe allergic reactions: Symptoms may include trouble breathing, hives, and swelling of the tongue, lips, mouth, or throat.
• Pancreatitis (inflammation of the pancreas): Symptoms usually start with mild or severe pain in the upper abdomen. Other signs include bloating, tenderness, nausea, vomiting, and diarrhea.
• Sphincter of Oddi spasm (a condition in which the sphincter muscle spasms, which can lead to the backup of bile or pancreatic enzymes in their ducts): Stop taking Viberzi if you think you're experiencing sphincter of Oddi spasm. Symptoms can include worsening abdominal pain that can radiate to the back or shoulder, with or without nausea and vomiting.
• Severe constipation

Dosage: How Much of Viberzi Should I Take?

Modifications

No studies have been done on Viberzi use during pregnancy or breastfeeding. As such, you should consult your healthcare provider if you become or plan to become pregnant. They may weigh the risks versus benefits of stopping Viberzi with you.

Talk to your healthcare provider about any liver or kidney issues you have. Dosage changes may be necessary for people with mild or moderate liver impairments, although those with severe liver problems should not be prescribed Viberzi. You may also be prescribed a reduced dose if you have moderate or severe kidney impairment.

It is also essential to keep in mind that if you are 65 or older, you may be more likely to have side effects associated with this drug.

Missed Dose

If you miss your dose of Viberzi, skip the missed dose and take the next scheduled dose at the usual time. Do not take extra to make up for the missed dose. Doing so can increase your risk for side effects.

Overdose: What Happens If I Take Too Much Viberzi?

There have not been any reports of an overdose with Viberzi. To be safe, do not take more than prescribed by your healthcare provider.

Precautions

What Are Reasons I Shouldn’t Take Viberzi?

There are a few reasons why your healthcare provider may not choose Viberzi as part of your treatment plan.

Allergy

A person should not take Viberzi if they are allergic to the ingredients.

Abuse/Dependence

Since Viberzi is a controlled substance, there is a risk of dependence.

Pregnancy

No studies have looked at Viberzi use during pregnancy. As such, it isn't certain if it will cause harm to the fetus. It is best to talk to your healthcare provider if you are pregnant or plan to become pregnant, so they can decide the best option for you.

Breastfeeding

It isn’t known if Viberzi passes into human milk. Talk with your healthcare provider if you are breastfeeding to discuss the best plan for you.

Older Adults

A person 65 years or older often processes drugs more slowly, which means they may be at higher risk of experiencing side effects. A lower dose or different schedule may be required.

Children

Viberzi has not been approved for use in children.

Other Health Conditions

In certain individuals, the body may handle this drug differently. A person should inform their healthcare provider if they have:

• Pancreatitis
• Constipation

What Other Medications Interact With Viberzi?

There are a few medications that can interact with Viberzi.

Medications that cause an increased risk of Viberzi side effects

When taken with these medications, more Viberzi can remain in the body, leading to an increased risk of side effects. A few examples of these medications include:

• Gengraf, Neoral, Sandimmune (cyclosporine)
• Lopid (gemfibrozil)
• Antiretrovirals (e.g., ritonavir, lopinavir)
• Rifadin (rifampin)
• Promacta (eltrombopag)

Medications that cause an increased risk of constipation

These medications also cause constipation and should not be taken with Viberzi:

• Opioids (e.g., hydrocodone)
• Anticholinergics
• Alosetron

Medications that have an increased risk of side effects when taken with Viberzi

Viberzi may cause an increased risk of side effects when taken with rosuvastatin. This can lead to an increased risk of myopathy or rhabdomyolysis.

This list does not include all drugs that can interact with Viberzi. Before using Viberzi, be sure to tell your healthcare provider about all the prescription medications, over-the-counter (OTC) medications, vitamins, supplements, or herbs you are taking. This will help you avoid potential interactions. If you have any questions about drug interactions, speak with your healthcare provider.

What Medications Are Similar?

Viberzi is often used to treat irritable bowel syndrome with diarrhea. There are a few other medications also used to treat irritable bowel syndrome with diarrhea, including:

• Xifaxan (rifaximin)
• Lotronex (alosetron HCL)

Xifaxan

Rifaximin is an antibiotic that works in the small intestine. It reduces abdominal pain, episodes of diarrhea, and bloating with irritable bowel syndrome with diarrhea. Xifaxan is available as an oral tablet. The most common side effects include headache, gas, nausea, and abdominal pain.

Lotronex

Alosetron HCL is a beta-blocker. It is often prescribed to treat irritable bowel syndrome with diarrhea in females (sex assigned at birth). Lotronex is available as an oral tablet. Common side effects include constipation, abdominal pain, or nausea. Lotronex does have a black box warning about ischemic colitis and severe complications of constipation.

Loperamide, an opioid agonist, is a commonly used OTC antidiarrheal medication to help reduce symptoms of acute diarrhea. However, clinical trials around its efficacy for pain relief in IBS have produced mixed results. It may not adequately control pain and bloating symptoms. The American College of Gastroenterology does not recommend using loperamide for overall symptom relief in people with IBS.

This list is a list of examples of medications used to treat irritable bowel syndrome with diarrhea. It is not a list of drugs recommended to take with Viberzi. Ask your healthcare provider if you have any questions.

How Can I Stay Healthy While Taking Viberzi?

Viberzi is a safe and effective medication when used correctly. This drug is often used to treat irritable bowel syndrome with diarrhea in adults.

In addition to drug treatment, a low-FODMAP diet may also help relieve your symptoms. Similarly, you can also try the following diet changes:

• Eat smaller meals
• Avoid high-fat meals
• Avoid fried foods
• Keep a food diary
• Identify and avoid trigger foods

While Viberzi does have the potential for serious side effects such as allergic reactions or pancreatitis, the most common side effects may be milder. Those tend to include abdominal pain, nausea, or constipation.

It is important to inform your healthcare provider of all your health conditions and any prescription medications, OTC medications, vitamins, supplements, or herbs you are taking. This way, your healthcare provider can decide what medication and dose are safe and work best for you.