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CHAPTER 18 Gastrointestinal System

Antidiarrheals
Use

Adjunctive treatment of
acute chronic diarrhea.

Example

Diphenoxylate with
atropine (Lomotil)
Schedule V

Half-life:
2.5 h
Route:
PO

Onset:
4560 min
Pregnancy
category: C

Peaks:
2h

Duration:
34 h

Pharmacokinetic:
Well absorbed from GI
tract; metabolized in
liver; eliminated in feces.

How it works

Acts locally and centrally to reduce intestinal motility.

Adult dose

Antidiarrheal: PO: Initially, 1520 mg/day in 34 divided

doses; then 515 mg/day in 23 divided doses.

Before administration

Check baseline hydration status (skin turgor, mucous membranes,

urinary status).

Obtain electrolytes if diarrhea has been moderate to severe for

more than 2 days.
Administration

Give without regard to meals. If GI irritation occurs, give with

food or meals.

Use liquid for children under 12 years.

After administration

Encourage adequate fluid intake.

Assess bowel sounds for peristalsis.
Monitor daily bowel activity; stool consistency (watery loose,
soft, semisolid, solid) and record times of evacuation.

Contraindications

Assess for abdominal disturbances.

Discontinue medication if abdominal distention occurs.
Monitor intake and output.
Provide safe environment.

Obstructive jaundice, diarrhea associated with pseudomembranous enterocolitis due to broad-spectrum antibiotics
or with organisms that invade intestinal mucosa (E.coli,
Shigella, Salmonella), acute ulcerative colitis (may produce
toxic megacolon).

Cautions: Advanced hepatorenal disease, abnormal liver function.

CHAPTER 18 Gastrointestinal System

Antidiarrheals (continued)
Side effects/
adverse reaction

Frequent: Drowsiness, lightheadedness, dizziness, nausea.

Occasional: Headache, dry mouth.
Rare: Flushing, tachycardia, urinary retention, constipation,
paradoxical reaction (restlessness, agitation), blurred vision.
Adverse/toxic:

Dehydration may predispose to toxicity. Paralytic ileus, toxic

megacolon (constipation, decreased appetite, stomach pain
with nausea/vomiting) occurs rarely. Severe anticholinergic
effects (severe drowsiness, hypotonic reflexes, hyperthermia)
may result in severe respiratory depression, coma.
Patient education

Avoid tasks that require alertness or motor skills until response

to drug is established.

Do not ingest alcohol or barbiturates.

Report fever, palpitations, or abdominal distention or if
diarrhea persists.