Antidiarrheal Drugs

Definition

Antidiarrheal drugs are medicines that relieve diarrhea.

Purpose

Antidiarrheal drugs help control diarrhea and some of the symptoms that go along with it. An average, healthy person has anywhere from three bowel movements a day to three a week, depending on that person's diet. Normally the stool (the material that is passed in a bowel movement) has a texture something like clay. With diarrhea, bowel movements may be more frequent, and the texture of the stool is thin and sometimes watery.

Diarrhea is not a disease, but a symptom of some other problem. The symptom may be caused by eating or drinking food or water that is contaminated with bacteria, viruses, or parasites, or by eating something that is difficult to digest. People who have trouble digesting lactose (milk sugar), for example, may get diarrhea if they eat dairy products. Some cases of diarrhea are caused by stress, while others are brought on by taking certain medicines.

Description

Antidiarrheal drugs work in several ways. The drug loperamide, found in Imodium A-D, for example, slows the passage of stools through the intestines. This allows more time for water and salts in the stools to be absorbed back into the body. Adsorbents, such as attapulgite (found in Kaopectate) pull diarrhea-causing substances from the digestive tract. However, they may also pull out substances that the body needs, such as enzymes and nutrients. Bismuth subsalicylate, the ingredient in Pepto-Bismol, decreases the secretion of fluid into the intestine and inhibits the activity of bacteria. It not only controls diarrhea, but relieves the cramps that often accompany diarrhea.

These medicines come in liquid, tablet, caplet, and chewable tablet forms and can be bought without a physician's prescription.

Recommended dosage

The dose depends on the type of antidiarrheal drug. Read and follow the directions on the product label. For questions about dosage, check with a physician or pharmacist. Never take larger or more frequent doses, and do not take the drug for longer than directed.

Precautions

Diarrhea usually improves within 24-48 hours. If the problem lasts longer or if it keeps coming back, diarrhea could be a sign of a more serious problem. Anyone who has any of the symptoms listed below should get medical attention as soon as possible:

• diarrhea that lasts more than two days or gets worse
• fever
• blood in the stool
• vomiting
• cramps or tenderness in the abdomen
• signs of dehydration, such as decreased urination, dizziness or lightheadedness, dry mouth, increased thirst, or wrinkled skin

Do not use antidiarrheal drugs for more than two days unless told to do so by a physician.

Severe, long-lasting diarrhea can lead to dehydration. In such cases, lost fluids and salts, such as calcium, sodium, and potassium, must be replaced.

People older than 60 should not use attapulgite (Kaopectate, Donnagel, Parepectolin), but may use other kinds of antidiarrheal drugs. However, people in this age group may be more likely to have side effects, such as severe constipation, from bismuth subsalicylate. Ask the pharmacist for more information.

Bismuth subsalicylate may cause the tongue or the stool to temporarily darken. This is harmless. However, do not confuse this harmless darkening of the stool with the black, tarry stools that are a sign of bleeding in the intestinal tract.

KEY TERMS

Colitis— Inflammation of the colon (large bowel).

Dehydration— Excessive loss of water from the body.

Enzyme— A type of protein, produced in the body, that brings about or speeds up chemical reactions.

Nutrient— A food substance that provides energy or is necessary for growth and repair. Examples of nutrients are vitamins, minerals, carbohydrates, fats, and proteins.

Children with flu or chicken pox should not be given bismuth subsalicylate. It can lead to Reye's syndrome, a life-threatening condition that affects the liver and central nervous system. To be safe, never give bismuth subsalicylate to a child under 16 years without consulting a physician. Children may have unpredictable reactions to other antidiarrheal drugs. Loperamide should not be given to children under six years and attapulgite should not be given to children under three years unless directed by a physician.

Anyone who has a history of liver disease or who has been taking antibiotics should check with his or her physician before taking the antidiarrheal drug loperamide. A physician should also be consulted before anyone with acute ulcerative colitis or anyone who has been advised to avoid constipation uses the drug.

Loperamide should not be used by people whose diarrhea is caused by certain infections, such as salmonella or shigella. To be safe, check with a physician before using this drug.

Anyone who has a medical condition that causes weakness should check with a physician about the best way to treat diarrhea.

Special conditions

Before taking antidiarrheal drugs, be sure to let the physician know about any of these conditions:

ALLERGIES. Anyone who has had unusual reactions to aspirin or other drugs containing salicylates should check with a physician before taking bismuth subsalicylate. Anyone who has developed a rash or other unusual reactions after taking loperamide should not take that drug again without checking with a physician. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.

PREGNANCY AND BREASTFEEDING. Women who are pregnant or breastfeeding should check with their physicians before using antidiarrheal drugs. They should also ask advice on how to replace lost fluids and salts.

OTHER MEDICAL CONDITIONS. Before using antidiarrheal drugs, people with any of these medical problems should make sure their physicians are aware of their conditions:

• dysentery
• gout
• hemophilia or other bleeding problems
• kidney disease
• stomach ulcer
• severe colitis
• liver disease

USE OF CERTAIN MEDICINES. Taking antidiarrheal drugs with certain other drugs may affect the way the drugs work or may increase the chance of side effects.

Side effects

The most common side effects of attapulgite are constipation, bloating, and fullness. Bismuth subsalicylate may cause ringing in the ears, but that side effect is rare. Possible side effects from loperamide include skin rash, constipation, drowsiness, dizziness, tiredness, dry mouth, nausea, vomiting, and swelling, pain, and discomfort in the abdomen. Some of these symptoms are the same as those that occur with diarrhea, so it may be difficult to tell if the medicine is causing the problems. Children may be more sensitive than adults to certain side effects of loperamide, such as drowsiness and dizziness.

Other rare side effects may occur with any antidiarrheal medicine. Anyone who has unusual symptoms after taking an antidiarrhea drug should get in touch with his or her physician.

Interactions

Attapulgite can decrease the effectiveness of other medicines taken at the same time. Changing the times at which the other medicines are taken may be necessary. Check with a physician or pharmacist to work out the proper dose schedule.

Bismuth subsalicylate should not be taken with aspirin or any other medicine that contains salicylate. This drug may also interact with other drugs, such as blood thinners (warfarin, for example), methotrexate, the antigout medicine probenecid, and the antidiabetes drug tolbutamide. In addition, bismuth subsalicylate may interact with any drug that interacts with aspirin. Anyone taking these drugs should check with a physician or pharmacist before taking bismuth subsalicylate.