Antidiarrheal: Difference between revisions
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{{Short description|Medication used to manage and reduce diarrhea}} | {{Short description|Medication used to manage and reduce diarrhea}} | ||
Antidiarrheals are a class of [[medication]] used primarily to manage and reduce the frequency of [[diarrhea]]. This class of medication predominantly works by slowing digestion, reducing fluid loss, or improving absorption. There are four main classes: [[opiate]]s, [[5-HT3 receptor|5-HT<sub>3</sub>]] receptor antagonists, [[Adsorption|adsorbents]], and bulk-forming agents.<ref>{{Cite journal |last=Lee |first=Kwang Jae |date=2015 |title=Pharmacologic Agents for Chronic Diarrhea | Antidiarrheals are a class of [[medication]] used primarily to manage and reduce the frequency of [[diarrhea]]. This class of medication predominantly works by slowing digestion, reducing fluid loss, or improving absorption. There are four main classes: [[opiate]]s, [[5-HT3 receptor|5-HT<sub>3</sub>]] receptor antagonists, [[Adsorption|adsorbents]], and bulk-forming agents.<ref>{{Cite journal |last=Lee |first=Kwang Jae |date=2015 |title=Pharmacologic Agents for Chronic Diarrhea |journal=Intestinal Research |language=en |volume=13 |issue=4 |pages=306–312 |doi=10.5217/ir.2015.13.4.306 |pmid=26576135 |pmc=4641856 |issn=1598-9100 |doi-access=free }}</ref> Commonly used medications include [[loperamide]] (Imodium), [[diphenoxylate]], [[bismuth subsalicylate]] (Pepto-Bismol), [[Colestyramine|Cholestyramine]], and [[Octreotide]].<ref name=":02">{{Cite journal |last=Schiller |first=Lawrence R. |date=May 2017 |title=Antidiarrheal Drug Therapy |url=http://link.springer.com/10.1007/s11894-017-0557-x |journal=Current Gastroenterology Reports |language=en |volume=19 |issue=5 |article-number=18 |doi=10.1007/s11894-017-0557-x |pmid=28397130 |issn=1522-8037|url-access=subscription }}</ref> Although not considered an antidiarrheal, [[Oral rehydration therapy|oral rehydration solutions]] are also an important aspect of managing diarrhea.<ref name=":02" /> | ||
== Medical use == | == Medical use == | ||
=== Acute diarrhea === | === Acute diarrhea === | ||
Acute diarrhea is a common condition that typically resolves on its own with [[oral rehydration therapy]].<ref name=":02" /> Most cases of acute diarrhea are caused by infections from contaminated food or water and usually go away on their own within a week.<ref>{{Cite journal | | Acute diarrhea is a common condition that typically resolves on its own with [[oral rehydration therapy]].<ref name=":02" /> Most cases of acute diarrhea are caused by infections from contaminated food or water and usually go away on their own within a week.<ref>{{Cite journal |last1=Thielman |first1=Nathan M. |last2=Guerrant |first2=Richard L. |date=January 2004 |title=Acute Infectious Diarrhea |url=https://www.nejm.org/doi/abs/10.1056/NEJMcp031534 |journal=New England Journal of Medicine |language=en |volume=350 |issue=1 |pages=38–47 |doi=10.1056/NEJMcp031534 |pmid=14702426 |issn=0028-4793|url-access=subscription }}</ref> The most common causes of acute diarrhea in children are the viral agents [[norovirus]] and [[rotavirus]], accounting for about 70% of cases.<ref>{{Cite book |title=Pediatric gastrointestinal and liver disease |date=2021 |publisher=Elsevier |isbn=978-0-323-67293-1 |editor-last=Wyllie |editor-first=Robert |edition=Sixth |location=Philadelphia, PA |editor-last2=Hyams |editor-first2=Jeffrey S. |editor-last3=Kay |editor-first3=Marsha}}</ref> [[Travelers' diarrhea|Travelers’ diarrhea]] (TD) is one of the most common illnesses affecting people of all ages abroad, with up to 70% of travelers developing symptoms within two weeks.<ref name=":2">{{Cite web |title=Travelers' Diarrhea {{!}} CDC Yellow Book 2024 |url=https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/travelers-diarrhea |access-date=2025-03-26 |website=wwwnc.cdc.gov}}</ref> While traditional advice like avoiding uncooked or unpeeled foods was once thought to be effective, poor sanitation and food handling practices—especially in local eateries—remain major risk factors.<ref name=":2" /> | ||
Anti-motility medications like loperamide and diphenoxylate can help manage the symptoms of travelers’ diarrhea by reducing the frequency of bowel movements, which can be helpful when needing to travel, but are not curative.<ref name=":2" /> Loperamide and diphenoxylate should be avoided in people with bloody diarrhea or a fever, and loperamide is typically not recommended for children under six.<ref name=":2" /> Additionally, [[Zinc|zinc supplements]], particularly in children, can reduce diarrheal duration by up to 25% and reduce stool volume by up to 30%.<ref name=":3">{{Cite web |title=Diarrhoeal disease |url=https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease |access-date=2025-03-26 |website=www.who.int |language=en}}</ref> | Anti-motility medications like loperamide and diphenoxylate can help manage the symptoms of travelers’ diarrhea by reducing the frequency of bowel movements, which can be helpful when needing to travel, but are not curative.<ref name=":2" /> Loperamide and diphenoxylate should be avoided in people with bloody diarrhea or a fever, and loperamide is typically not recommended for children under six.<ref name=":2" /> Additionally, [[Zinc|zinc supplements]], particularly in children, can reduce diarrheal duration by up to 25% and reduce stool volume by up to 30%.<ref name=":3">{{Cite web |title=Diarrhoeal disease |url=https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease |access-date=2025-03-26 |website=www.who.int |language=en}}</ref> | ||
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=== Opiates === | === Opiates === | ||
Loperamide is effective and safe for treating chronic diarrhea. [[Diphenoxylate]] and [[difenoxin]] work similarly but can affect the brain at high doses, so they're combined with [[atropine]] to reduce misuse risks. Stronger opiates like [[morphine]] or [[codeine]] can treat severe diarrhea, but they're rarely prescribed due to the risk of misuse, and careful monitoring is needed.<ref name=":12">{{Cite journal | | Loperamide is effective and safe for treating chronic diarrhea. [[Diphenoxylate]] and [[difenoxin]] work similarly but can affect the brain at high doses, so they're combined with [[atropine]] to reduce misuse risks. Stronger opiates like [[morphine]] or [[codeine]] can treat severe diarrhea, but they're rarely prescribed due to the risk of misuse, and careful monitoring is needed.<ref name=":12">{{Cite journal |last1=Schiller |first1=Lawrence R. |last2=Pardi |first2=Darrell S. |last3=Sellin |first3=Joseph H. |date=2017-02-01 |title=Chronic Diarrhea: Diagnosis and Management |url=https://www.cghjournal.org/article/S1542-3565(16)30501-8/fulltext |journal=Clinical Gastroenterology and Hepatology |language=English |volume=15 |issue=2 |pages=182–193.e3 |doi=10.1016/j.cgh.2016.07.028 |issn=1542-3565 |pmid=27496381|url-access=subscription }}</ref> While generally safe, even when combined with antibiotics, the use of opiates may slightly increase the risk of acquiring antibiotic-resistant bacteria.<ref name=":2" /> | ||
=== Bismuth subsalicylate === | === Bismuth subsalicylate === | ||
[[Bismuth subsalicylate]] is commonly used for diarrhea, but long-term use raises safety concerns and should be monitored.<ref name=":12" /> Bismuth can cause common side effects such as nausea, a bitter taste, diarrhea, and darkened stools.<ref>{{Cite journal |last=Gorbach |first=Sherwood L. |date=September 1990 |title=Bismuth therapy in gastrointestinal diseases |url=https://linkinghub.elsevier.com/retrieve/pii/0016508590909838 |journal=Gastroenterology |language=en |volume=99 |issue=3 |pages=863–875 |doi=10.1016/0016-5085(90)90983-8|url-access=subscription }}</ref> Since it is a heavy metal, in may cause [[encephalopathy]] in rare cases.<ref name=":02" /> | [[Bismuth subsalicylate]] is commonly used for diarrhea, but long-term use raises safety concerns and should be monitored.<ref name=":12" /> Bismuth can cause common side effects such as nausea, a bitter taste, diarrhea, and darkened stools.<ref>{{Cite journal |last=Gorbach |first=Sherwood L. |date=September 1990 |title=Bismuth therapy in gastrointestinal diseases |url=https://linkinghub.elsevier.com/retrieve/pii/0016508590909838 |journal=Gastroenterology |language=en |volume=99 |issue=3 |pages=863–875 |doi=10.1016/0016-5085(90)90983-8|pmid=2199292 |url-access=subscription }}</ref> Since it is a heavy metal, in may cause [[encephalopathy]] in rare cases.<ref name=":02" /> | ||
=== Bile acid resins === | === Bile acid resins === | ||
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|[[Colesevelam]] | |[[Colesevelam]] | ||
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|[[Fiber]] | |[[Dietary fiber|Fiber]] | ||
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{{Authority control}} | {{Authority control}} | ||
[[Category:Antidiarrhoeals| | [[Category:Antidiarrhoeals| ]] | ||