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Clinical management

Amitriptyline an effective second line treatment for IBS


  • A trial across 55 general practices in England aimed to determine the effectiveness of amitriptyline as a second-line treatment for irritable bowel syndrome (IBS).

  • 463 participants were randomly allocated to receive low-dose amitriptyline (10mg, with dose titration up to 30mg over 3 weeks) or placebo for 6 months. The IBS Severity Scoring System (IBS-SSS) was used to assess response to amitriptyline compared to placebo.

  • There was a significant improvement in the IBS-SSS after 6 months treatment with amitriptyline compared to placebo.


WiseGP Action


  • For people with IBS who don’t improve with first line therapies, offer low-dose amitriptyline. See a leaflet on the rationale for using amitriptyline and a dose titration document co-developed with patients here:

  • Reflect on your clinical management of IBS cases and whether you discuss the brain-gut axis and explore/ support the management of psychological comorbidities.

  • Consider signposting patients to the IBS self-care programme- perhaps you could add this link to an automated text message at your practice?



Read more about the research informing this GEM here:

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