6 Viberzi Side Effects and How to Manage Them

Stomach pain and diarrhea shouldn’t rule your life. But if you have irritable bowel syndrome with diarrhea (IBS-D), that can be an ongoing battle. 

IBS-D is a health condition that causes cramping, abdominal pain, and diarrhea. It can also cause gas, bloating, and a frequent need to use the restroom. Many medications can treat these symptoms, with Viberzi (eluxadoline) being one of them. Viberzi offers relief from diarrhea and abdominal pain by slowing down the movement of food through the digestive tract.

Most adults take Viberzi twice daily with a meal or snack. But your gastroenterologist (digestive system specialist) may recommend taking a lower dosage if you’re having difficulty tolerating the medication due to side effects. While common Viberzi side effects are relatively mild and manageable, there is a possibility for more concerning side effects.

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Viberzi side effects at a glance

While many people are able to take Viberzi with no issues, side effects are still possible. Viberzi’s most common side effects include:

• Constipation

• Nausea

• Stomach or abdominal pain

• Bloating

• Dizziness

• Gas

• Rashes

• Respiratory infections

Less common but potentially serious Viberzi side effects include:

• Severe constipation

• Inflammation of the pancreas (pancreatitis)

• Spasming of a muscle in the digestive system (sphincter of Oddi spasm)

• Allergic reactions

Here, we’ll discuss six notable Viberzi side effects to be aware of. We’ll also detail some management tips that may help you on your journey to better gut health. 

1. Constipation

Viberzi is effective at reducing diarrhea. However, because of how it works, it can cause the opposite problem as a side effect: constipation.

There are some proactive measures you can take to manage constipation related to Viberzi. First and foremost, drink plenty of water throughout the day. Fluids help keep things moving. Regular physical activity, such as daily walks, also promotes gut movement.

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Eating fiber is probably one of the last things you’d think to do when you have diarrhea. However, consuming foods high in soluble fiber, such as oats, flaxseed, and oranges, can be beneficial. This type of fiber can help soften harder stools while also providing firmness to loose ones.

Another option is asking a pharmacist for over-the-counter (OTC) constipation product recommendations. They’ll be able to suggest a medication, such as Metamucil (psyllium husk), or a supplement that’s safe for you to take.

Good to know: Speak to your gastroenterologist if you’re still feeling constipated after trying the above management tips. They may consider adjusting your Viberzi dosage so you maintain a better balance between symptom and side effect control. They, or your pharmacist, can also help you avoid any medications that may be contributing to your constipation.

2. Nausea

While IBS-D can cause nausea on its own, it’s also a possible side effect of Viberzi. Viberzi may cause new or worsening nausea in some people. 

Nausea related to Viberzi should go away with time. But you can take steps to combat it in the meantime. Eating smaller, more frequent meals and avoiding spicy, fried, or oily foods, which can irritate the stomach, are two easy things you can try. Drinking ginger or peppermint tea can also help if your stomach isn’t feeling quite right. 

Reach out to your gastroenterologist if you have persistent, uncomfortable nausea. They may consider adjusting your Viberzi dosage and suggest other ways to ease your symptoms.

3. Abdominal pain

Many people experience relief from abdominal pain after taking Viberzi. But it’s been connected to worsening abdominal pain in a small number of people.

Taking Viberzi with meals should help reduce stomach irritation. But it’s still a good idea to eat smaller, more frequent meals (versus a few larger ones) throughout the day.

Speak to your gastroenterologist if you continue to experience abdominal pain while taking Viberzi. Keep track of where you have pain and what it feels like. And communicate this information to your gastroenterologist so they can adjust your treatment plan as needed. After all, abdominal pain may be a symptom of undertreated IBS-D, rather than a Viberzi side effect.

And make sure to listen to your body. Seek immediate medical attention if you have severe abdominal pain at any point. Severe abdominal pain may be a sign of pancreatitis, which warrants prompt treatment.

4. Pancreatitis

In rare cases, Viberzi can cause pancreatitis. Pancreatitis is a potential medical emergency that occurs when the pancreas — an organ near the stomach — becomes inflamed. One of the main symptoms of pancreatitis is severe abdominal pain. This may or may not be accompanied by nausea and vomiting. 

You may experience abdominal pain anywhere from the upper-right part of your stomach to your back or shoulder with pancreatitis. In Viberzi’s clinical studies, pancreatitis occurred most often during the first week of treatment.

You’re at an increased risk of developing pancreatitis if you don’t have a gallbladder. You’re also at an increased risk if you drink more than 3 alcoholic beverages per day. So it’s a good idea to consider reducing your alcohol intake while taking Viberzi. 

Stop taking Viberzi and go to the nearest ER right away if you’re experiencing intense abdominal pain that doesn’t go away. You’ll be given tests to determine the cause of your symptoms and what time of treatment is needed.

Your gastroenterologist will likely suggest trying other IBS-D treatment options if you experience pancreatitis while taking Viberzi. 

5. Sphincter of Oddi spasms

The sphincter of Oddi is a small-but-important muscle in the digestive system. It controls the flow of digestive juices into the intestines. Viberzi can cause this muscle to clamp up, spasm, or act abnormally. You may experience severe abdominal pain that can travel to your back or shoulder if this happens.

Seek medical attention right away if you experience severe abdominal pain while taking Viberzi. Sphincter of Oddi spasms, which occur most often in the first week of treatment and in people that don’t have a gallbladder, can lead to pancreatitis. 

Like with pancreatitis, continuing treatment with Viberzi is not recommended if you develop sphincter of Oddi spasms. Your gastroenterologist will likely suggest other IBS-D treatment options if you develop this side effect.

6. Dependence and misuse

Viberzi may not come to mind when you think of medications associated with dependence or misuse. More likely, you think of medications like Xanax (alprazolam) or opioid pain relievers. But Viberzi is considered a controlled substance because it does have a potential to cause these issues. Though, the risk is small overall.

Viberzi carries a risk of dependence and misuse because it works on the same receptors as some opioid medications. The key difference is that it mostly works in the digestive system. Very little Viberzi makes its way into your brain, where it could influence reward pathways that are associated with dependence. This is why the medication is listed as a Schedule 4 controlled substance, rather than a Schedule 2 or 3 substance.

Still, it's important to take Viberzi exactly as prescribed by your gastroenterologist. Taking more Viberzi than prescribed or taking it in a way that is different from how it’s prescribed can lead to negative health outcomes. Medication misuse can also increase your risk of side effects, including those that can affect the liver and pancreas. 

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Written by:

Mandeep Sohal, PharmD

Mandeep Sohal, PharmD, has more than 7 years of experience in the pharmaceutical industry and is licensed in California. In his career, he’s had experience with specialty pharmacy, community pharmacy, pharmacy benefit management, and pharmaceutical manufacturers.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Bailey E. Eason, PharmD, MS, BCPS

Bailey Eason has been licensed for 6 years and has held licenses in three states (North Carolina, Virginia, and Illinois). She has held positions as a health-system pharmacy administration resident, operating room pharmacy manager, pharmacy manager of clinical operations: surgery, neurology and controlled substances, and most recently as program director  of drug diversion for a large academic health system.

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