ANTIDIARRHEAL DRUGS

WHAT IS DIARRHEA MANAGEMENT OF DIARRHEA

 Excessive and frequent evacuation of watery feces MILD :

 Due to :
- Plenty of water
- ↑ motility of GIT
- ↓ absorption of fluid MODERATE (lost electrolyte) :
 Accompanied by gas, cramping, urgency to defecate
- ORS (glucose, NaCl, KCl, trisodium citrate)
 Nausea & vomiting – if caused by infectious organism
or toxicity SEVERE :

CAUSES OF DIARRHEA - IV of NaCl

ACUTE (3 days to 2 weeks) :

- Bacterial, viral, protozoa
- Drug-induced
- Food poisoning
CHRONIC (>3 weeks) :
- Tumors
- Diabetes
- Addison’s dz
- Hyperthyroidism
- Irritable bowel syndrome
# associated with recurring passage of diarrheal stool, fever,
loss appetite, nausea, vomiting, weight loss, chronic weakness
 DRUGS DESCRIPTION/ MOA ADVERSE EFFECT
PHARMACOKINETIC
ANTIMOTILITY AGENTS Anticholinergic Anticholinergic Anticholinergic
 Alone or in combination Decrease intestinal muscle tone &  Urinary retention,
Anticholinergic peristalsis hesitancy
↓  Headache, dizziness,
Opioid drug Slowing movement of fecal matter confusion, anxiety,
- Diphenoxylate drowsiness
- Loperamide Opioid drug  Dry skin, rash, flushing
- Codeine phosphate Act on presynaptic opioid receptor  Blurred vision,
- Morphine ↓ photophobia, ↑
Inhibit Ach release intraocular pressure
↓  Hypo/hypertension,
Decrease peristalsis brady/tachycardia
↓
Slowing movement of fecal matter Opioid drug
 Drowsiness
 Abdominal cramps
 Not advisable for children
& severe colitis
(can cause toxic megacolon)

ANTISPASMODIC  Relieve muscle spasm

 Useful in :
- Anticholinergic - Symptomatic relief
- Alverine citrate - Irritable bowel syndrome
- Mebeverine - Diverticular dz
hydrochloride
- Peppermint oil
 MUCOSAL PROTECTANT
& ADSORBENT
- Activated charcoal
- Bismuth subsalicylate
kaolin-pectin
- Methylcellulose
- Aluminium hydroxide
 DO NOT GIVE bismuth
subsalicylate to children <16 years
old & with chicken pox (risk for
Reye’s syndrome)
 Coat the walls of GIT
Bind to causative bacteria/toxin
 Adsorbing intestinal toxin & micro
 Coating/protecting the intestinal
mucosa
 Modify fluid & electrolyte transport
 Decrease fluid secretion
 Increased bleeding time
 Constipation, dark stools
 Confusion, twitching
 Hearing loss, tinnitus,
metallic taste, blue gums
DRUG INTERACTION :
 ↓ absorption of digoxin,
clindamycin, quinidine,
hypoglycemic agents
 ↑ bleeding time when
given with anticoagulants
 Antacid can ↓ effect of
anticholinergic action

BULKING AGENT
- Methylcellulose

ANTIMICROBIAL

# DO NOT GIVE anticholinergic to ptn with history of :

- Glaucoma
- BPH
- Urinary retention
- Recent bladder surgery
- Cardiac problems
- Myasthemia gravis