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Drugs Used in Diarrhea

By: alien

Diarrhea is one of the great killers of children in India. It is characterized by frequent passage of liquid or semisolid stools and may be accompanied by abdominal (gripping) pain. When diarrhoea is associated with abdominal pain and passage of blood and mucous due to infection or inflammation of the intestines, it is called dysentery. In dysentery there is an excessive loss of fluids and salts from the body. Diarrhea associated with vomiting, may lead to serious consequences like dehydration, shock and death. Infants, children, and elderly debilitated persons are more susceptible to dehydration, and for this reason diarrhoea is a more serious problem in them than in young adults.

Anti-motility Drugs in Diarrhoea

A number of drugs are used to oppose the increased intestine movements in diarrhoea. But overall utility of such drugs is limited and these are often misused.

Diphenoxylate (Lomotil)

Diphenoxylate is a drug related to the painkiller pethidine. It is available in combination with atropine, an anti-spasmodic drug which relieves gripping or colicky pain. The combination is sold under the trade name LOMOTIL containing atropine 0.025 mg and diphenoxylate 2.5 mg.

Adverse Effects: If taken in larger doses over a period of time, it may cause addiction. In children, LOMOTIL has been reported to cause retention of toxic substances in the intestines as a consequence of decreased mobility. The toxicity in children includes dryness of mouth, blurring of vision, urinary retention, distension of abdomen due to toxin stay (loss of bowel activity causes retention of toxins which further reduces bowel movement leading to distension) marked respiratory depression, coma, and even death. Some of these symptoms can appear even with near therapeutic doses. Therefore it is banned in children below the age of six years.

Loperamide

It has a poor penetration through the blood-brain barrier and therefore does not cause addiction and sedation in therapeutic doses. It is more potent than diphenoxylate. These are never given if diarrhoea is due to ulcerative colitis, diverticulitis or irritable bowel syndrome. The average daily adult dose is 4 to 8 mg and should not exceed 16 mg. It is not recommended in children less then 2 years of age. Dose 2 to 5 years (13 to 20 kg) 1 mg; 6 to 8 years (20 to 30 kg) 2 mg twice a day.

Adverse Effects: Abdominal cramp and skin rashes are the main side-effects of this drug. Same precautions should be observed as for LOMOTIL.

Racecadotril (Redotril 100 mg)

This is a newer drug which reduces fluid secretion and its loss in stools. It is useful in viral and watery diarrhoea in diabetics in a dose of 100 mg three times a day. It may cause nausea, thirst, giddiness and headache. It is safer than diphenoxylate and codeine. Codeine was the time tested drug but because of its addiction potential and availability of newer and safer agents, it is rarely used for its anti motility effects.

Isapgol (Sat Isabgol)

It is generally used in the treatment of constipation, but is also effective in mild diarrhoea

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