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• GJF
  • Joint Wound Care Formulary
  • . . . Introduction
  • 1. Gastro-Intestinal System
    • 1.1 Dyspepsia and Gastro-oesophageal reflux disease
    • 1.2 Antispasmodics and other drugs altering gut motility
    • 1.3 Antisecretory drugs and mucosal protectants
    • 1.4 Antidiarrhoeal drugs
    • 1.5 Chronic bowel disorders
    • 1.6 Laxatives
    • 1.7 Local Preparations for anal and rectal disorders
    • 1.9 Drugs affecting intestinal secretions
  • 2. Cardiovascular System
  • 3. Respiratory System
  • 4. Central Nervous System
  • 5. Infections
  • 6. Endocrine System
  • 7. Obstetrics, Gynaecology and Urinary Tract Disorders
  • 8. Malignant Disease and Immunosuppresion
  • 9. Nutrition and Blood
  • 10. Musculoskeletal and Joint Disease
  • 11. Eye
  • 12. Ear, Nose and Oropharynx
  • 13. Skin
  • 14. Immunological products and vaccines
  • 15. Anaesthesia
  • Appendix 1. Drugs for emergency use in General Practice
  • Appendix 2. Palliative Care
  • Appendix 3. Oral Nutritional Supplements (ONS)
  • Appendix 4. Gluten-free and cow's milk protein-free products
  • Medicines No Longer included in the GJF
  • Medicines not recommended for use in NHS Grampian
• eGJF
• Medicines Management
• Policies
• News Letters
• Shared Care Protocols
• Patient Group Directions

1.4 Acute diarrhoea

Loperamide (capsules, syrup) may be used as an adjunct to rehydration in acute diarrhoea and for chronic diarrhoea in adults. It is unlikely to cause dependence and central side-effects.

Codeine phosphate (tablets) is an effective antidiarrhoeal. It is only suitable for short-term use because of the risk of CNS side-effects and dependence.

PRESCRIBING POINTS FOR ANTIDIARRHOEAL DRUGS

• If clostridium difficile is suspected, see Chapter 5, all antidiarrhoeals are contraindicated.
• Antibiotics should not be given for acute diarrhoea until an infected cause is diagnosed (see Chapter 5).
• Diarrhoea may require fluid and electrolyte replacement. This is particularly important in infants and in frail or elderly patients. For oral rehydration preparations, see 9.2.1.
• Patients with chronic diarrhoea need individualised treatment including dietary manipulation as well as drug treatment and maintenance of a liberal fluid intake. This will depend on underlying diagnosis.
• Antidiarrhoeal drugs which reduce gastro-intestinal motility should not be used in children.
• Antidiarrhoeal drugs should not be given to patients with acute colitis as they may cause toxic megacolon.
• Bulk-forming drugs, such as ispaghula are useful in controlling faecal consistency in ileostomy and colostomy patients, and in controlling diarrhoea associated with diverticular disease.
• Co-phenotrope (proprietary name, Lomotil®) is not recommended. The combination of diphenoxylate hydrochloride and atropine frequently causes side-effects. Overdosage is particularly dangerous in children.

PAEDIATRIC NOTES - ANTIDIARRHOEAL DRUGS

Oral rehydration (see 9.2.1) is the first line treatment for dehydration in children.
Antidiarrhoeal drugs should not be used to treat acute diarrhoea in children under 12 years. In cases of chronic diarrhoea, infection should be excluded before antidiarrhoeal drugs are prescribed.
Loperamide is preferable to codeine. It is not licensed for use in children under 4 years old. It should not be used for acute infectious diarrhoea. Long-term use should be managed under close medical supervision.
Preparations containing absorbents, such as kaolin, are not recommended.

GERIATRIC NOTES - ANTIDIARRHOEAL DRUGS

Acute or prolonged diarrhoea may require fluid replacement in frail and elderly patients. Faecal impaction in the frail elderly can give rise to "overflow" diarrhoea, and soiling. This should be excluded before antidiarrhoeals are started.

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