Diarrhea Treatments

How does fluid/electrolyte treatment help?

not a treatment to relieve diarrhea, but is used instead for rehydration and replacement of fluids/electrolytes

oral rehydration solutions (ORS):

fluids containing glucose, sodium, potassium, chloride, and bicarbonate or citrate

When should ORS be administered for adults/children > 5 yrs w/ 3-9% dehydration?

begin ORS @ 2-4 L over 3 hrs

Name commercially available ready-to-use ORS products:

• Pedialyte

• Enfalyte

• Rehydralyte

Why is lower osmolality generally preferred?

it promotes better absorption of fluids and electrolytes by the intestines

What are the two forms of pharmacologic therapy for diarrhea?

• anti-peristaltic (antimotility) agent: Loperamide

• antisecretory agent: Bismuth subsalicylate

What is a brand of loperamide?

Imodium A-D

What are available dosage forms for Imodium?

• oral caplates/soft gels: 2 mg

• oral liquid: 1 mg/7.5 mL

What is the MOA for loperamide?

(peripheral) opioid agonist: binds to opiate receptors in gut wall → inhibits release of acetylcholine + prostaglandins → reduces peristalsis + slows transit time + enhances water/electrolyte absorption

What is the general use of Imdoium A-D?

• reduces daily fecal volume

• increases the viscosity/bulk density

• diminishes the loss of fluid and electrolytes

What is the duration of use for loperamide?

about 48 hrs

What is the recommended form of loperamide (Imodium) for pts > 6 yrs?

either caplets or oral solution

What is the recommended form of loperamide for pts >12 yrs?

every form (soft gels, caplets, oral solution)

How frequent should pts >12 yrs take loperamide?

2 caplets after first stool → 1 caplet after each subsequent stool (no more than 4 in 24 hrs)

How frequent should pts 9-11 yrs take loperamide?

1 caplet after first stool → ½ caplet after each subsequent stool (no more than 3 in 24 hrs)

How frequent should pts 6-8 yrs take loperamide?

1 caplet after the first loose stool → ½ caplet after each subsequent loose stool (no more than 2 in 24 hrs)

When should loperamide be avoided?

in invasive bacterial diarrhea → risk of worsening illness or toxic megacolon

What are potential adverse effects of loperamide?

• common: mild dizziness or constipation

• rare: abdominal pain, distention, nausea, hypersensitivity

• severe: torsades de pointes, sudden death

What are brands of bismuth subsalicylate?

• PeptoBismol

• PeptoBismol Chewables

• Kaopectate

What are available dosage forms for bismuth subsalicylate?

• oral suspension: 262 mg/mL, 525 mg/mL

• tablets/caplets: 262 mg

How frequent should pts take tablets/caplets of peptobismol?

525 mg every 30 min to 1 hr as needed for MAX of 8 doses/24 hrs

How frequent should pts take the 262mg/15mL liquid form of peptobismol?

525 mg (30mL) every 1 hr up to 240 mL/day (8 doses)

How frequent should pts take the 525mg/15mL liquid form of peptobismol?

1050 mg (30 mL) every 1 hr up to 120 mL/day (4 doses)

What is the MOA for bismuth subsalicylate?

• 42% salicylate → antisecretory leading to decreased fluid/electrolyte loss, increased stool consistency, decreased nausea/vomiting/cramps

• 58% bismuth → direct antimicrobial effects against bacteria

What are potential adverse effects of bismuth subsalicylate?

• common: constipation, discoloration of the tongue, black stained stools

• uncommon: tinnitus, neurotoxicity, slurred speech, muscle spasms, weakness

What are contraindications to bismuth subsalicylate?

• salicylate allergy

• taking aspirin or other salicylates (reaching toxic levels)

• GI ulcers or bleeding issues

• children <18 yrs w/ viral illness → increased risk of Reye’s syndrome

• concurrent use with anticoagulants, antiplatelets, or NSAIDS → increased risk of bleeding

Which drug is preferred for children <6 yrs old?

avoid both due to safety risks

Which drug is preferred for pts suffering from acute nonspecific diarrhea?

loperamide (Imodium)

Which drug is preferred for pts suffering from travelers’ diarrhea?

bismuth subsalicylate

Which drug is preferred for pts suffering from infectious diarrhea?

bismuth subsalicylate with antibiotics

Which drug is preferred for pts suffering from chronic diarrhea?

loperamide (Imodium) for slowing motility and increasing absorption