Medically reviewed by: Vitthia Rama Murti, BPharm Hons (University of Cyberjaya), RPh 15632 — Chief of Staff & Compounding Pharmacist, Lynnity Compounding Pharmacy.
Last reviewed: 27 May 2026.
IBS — common, real, and bidirectional gut-brain
Irritable bowel syndrome (IBS) affects an estimated 10–15% of Malaysian adults. The condition is real and physiological — disordered gut motility, altered gut–brain signalling, sometimes a post-infectious or microbiome trigger — and the diagnostic criteria (Rome IV) are well defined. Symptoms include cramping or bloating, altered bowel habit (diarrhoea, constipation, or alternating), and improvement of pain with defecation.
Standard treatment ladder
- Lifestyle: low-FODMAP diet trial, regular meals, stress management, exercise, soluble fibre (psyllium).
- First-line medications by subtype:
- IBS-D (diarrhoea-predominant): loperamide, low-dose tricyclic antidepressant (amitriptyline), rifaximin (where available).
- IBS-C (constipation-predominant): osmotic laxatives, prucalopride, linaclotide.
- IBS-mixed: targeted antispasmodics (hyoscine, mebeverine, peppermint oil).
- Adjuncts: gut-directed hypnotherapy, CBT.
Where compounding fits
Compounded formulations are useful when:
- The patient needs a non-standard dose of a TCA (e.g., amitriptyline 5 mg or 10 mg liquid — commercial tablets start at 10 mg and aren’t easily split).
- The patient is intolerant of excipients in the commercial product.
- A combination product is wanted — e.g., enteric-coated peppermint oil + L-glutamine + low-dose hyoscine in one capsule.
- A custom probiotic blend is wanted, formulated to specific CFU and strain.
Common Lynnity IBS-related compounds
| Compound | Use |
|---|---|
| Amitriptyline 5 / 10 mg capsule or liquid | Low-dose for visceral hypersensitivity in IBS-D / IBS-mixed |
| Nortriptyline 5 / 10 mg | Alternative TCA with fewer anticholinergic effects |
| Peppermint oil enteric-coated capsules (custom dose) | Antispasmodic; bypasses gastric release |
| L-glutamine powder (single ingredient, no fillers) | Gut-barrier support (research-stage but commonly used) |
| Hyoscine 5 / 10 mg compound | Custom-dose antispasmodic |
| Mebeverine custom-dose | When commercial dose not suitable |
| Loperamide compounded suspension | Paediatric or sub-1 mg dosing |
| Custom probiotic blends | Specific-strain, specific-CFU formulations |
Important notes
- IBS is a diagnosis of exclusion — coeliac disease, inflammatory bowel disease, lactose intolerance, and bile-acid diarrhoea can all mimic it. Get appropriately worked up.
- Low-dose amitriptyline / nortriptyline for IBS is a recognised off-label use; doses are far below those for depression (5–25 mg vs 75–150 mg).
- Probiotics for IBS — evidence is mixed and strain-specific. Discuss with your gastroenterologist.
How to start
See your GP or gastroenterologist. If they prescribe a compounded therapy, the prescription can be sent to Lynnity.
See also: Gastroenterology service page.
FAQ
Is low-dose amitriptyline for IBS the same as taking an antidepressant?
No. The dose used for IBS (5–25 mg) is much lower than antidepressant dose (75–150 mg). At low dose the action is on visceral pain and gut motility, not mood. Side effects (dry mouth, drowsiness) are also milder. Discuss with your prescriber.
Can I get rifaximin in Malaysia?
Rifaximin availability in Malaysia is limited. Lynnity does not compound rifaximin — talk to your gastroenterologist about availability through hospital pharmacies or alternatives.
Why do peppermint oil capsules need to be enteric-coated?
If peppermint oil dissolves in the stomach it causes reflux and burning. Enteric coating delays release to the small intestine, where the antispasmodic effect is needed. Always use enteric-coated peppermint oil for IBS.
Will a custom probiotic cure my IBS?
Probably not “cure”, but specific strains (e.g., Bifidobacterium infantis 35624) have evidence for symptom reduction in some patients. Probiotic response is highly individual — a 4-week trial is reasonable.
Should I do a low-FODMAP diet?
A short (4–6 week) low-FODMAP trial supervised by a dietitian is reasonable first-line. Long-term low-FODMAP is not recommended because it reduces gut microbiome diversity — the goal is to identify your specific triggers and reintroduce other FODMAPs.