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.