Anti- Diarrheals - Diarrhea treatment options

Anti- Diarrheals:

Kaopectate®	Lomotil® (dephenoxylate + atropine)
Loperamide ( Imodium® )	Pepto-Bismol® (bismuth subsalicylate):

Kaopectate®:

IMPORTANT:
In 2003, the active ingredient in Kaopectate was reformulated to contain bismuth subsalicylate, replacing attapulgite as the active ingredient. The FDA found attapulgite efficacy data to be inadequate.

INDICATIONS:
Symptomatic treatment of mild, nonspecific diarrhea; control of traveler's diarrhea (enterotoxigenic Escherichia coli ); as part of a multidrug regimen for H. pylori eradication to reduce the risk of duodenal ulcer recurrence

Mechanism of Action
Bismuth subsalicylate exhibits both antisecretory and antimicrobial action. This agent may provide some anti-inflammatory action as well. The salicylate moiety provides antisecretory effect and the bismuth exhibits antimicrobial directly against bacterial and viral gastrointestinal pathogens.

DOSING:
Oral:
Treatment of nonspecific diarrhea, control/relieve traveler's diarrhea: Subsalicylate (doses based on 262 mg/15 mL liquid or 262 mg tablets):

Children >12 years and Adults: 2 tablets or 30 mL every 30 minutes to 1 hour as needed up to 8 doses/24 hours

SUPPLIED:
Caplet, as subsalicylate (Pepto-Bismol®): 262 mg [sugar free; contains sodium 2 mg]

Liquid, as subsalicylate: 262 mg/15 mL (240 mL, 360 mL, 480 mL); 525 mg/15 mL (240 mL, 360 mL)

Lomotil® (dephenoxylate + atropine):

Adults: Dosing: Diarrhea: Oral: The initial oral dose of diphenoxylate is 2 tablets (5 mg) or (10 ml) 4 times daily. Most patients will require this dosage until control has been attained, after which the dose may be adjusted according to the individual response. Control may be maintained with 2 tablets or 10 mL daily

Diphenoxylate:
Onset of action: Antidiarrheal: 45-60 minutes
Peak effect: Antidiarrheal: ~2 hours
Duration: Antidiarrheal: 3-4 hours.
Half-life: 2.5 hours.

If there is no response with 48 hours, the drug is unlikely to be effective and should be discontinued; if chronic diarrhea is not improved symptomatically within 10 days at maximum dosage of 20 mg/day, control is unlikely with further use.

Supplied
Solution, oral: Diphenoxylate hydrochloride 2.5 mg and atropine sulfate 0.025 mg per 5 mL. Tablet (Lomotil®, Lonox®): Diphenoxylate hydrochloride 2.5 mg and atropine sulfate 0.025 mg.

Loperamide ( Imodium® ):

Adults: Dosing: [2 mg capsule /tablet]
Acute diarrhea: Oral: Initial: 4 mg, followed by 2 mg after each loose stool, up to 16 mg/day

Chronic diarrhea: Oral: Initial: Follow acute diarrhea; maintenance dose should be slowly titrated downward to minimum required to control symptoms (typically, 4-8 mg/day in divided doses)

Traveler's diarrhea: Oral: Initial: 4 mg after first loose stool, followed by 2 mg after each subsequent stool (maximum dose: 8 mg/day)

Pepto-Bismol® (bismuth subsalicylate):

DOSING: ADULTS
Treatment of nonspecific diarrhea, control/relieve traveler's diarrhea: Oral: Subsalicylate (doses based on 262 mg/15 mL liquid or 262 mg tablets): 2 tablets or 30 mL every 30 minutes to 1 hour as needed up to 8 doses/24 hours.

Helicobacter pylori eradication: Oral: 524 mg 4 times/day with meals and at bedtime; requires combination therapy.

Control of fecal odor in ileostomy or colostomy: Oral: Subgallate: 200-400 mg up to 4 times/day.

Disclaimer

Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.

David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.