page78
Colestyramine (section 1.9.2),
binds unabsorbed bile
salts and provides symptomatic relief of
diarrhoea fol-
lowing ileal disease or resection.
1.4.1
Adsorbents and bulk-
forming drugs
Adsorbents such as kaolin are not
recommended for
acute
diarrhoeas
.
Bulk-forming drugs,
such as
isp-
aghula,
methylcellulose,
and sterculia (section 1.6.1)
are
useful
in controlling diarrhoea
associated with
diverticular disease.
KAOLIN, LIGHT U
Indications
diarrhoea but see notes above
Cautions
interactions: Appendix 1 (kaolin)
Kaolin Mixture, BP U
(Kaolin Oral Suspension)
Oral suspension
, light kaolin or light kaolin (natural)
20%,
light magnesium carbonate 5%,
sodium bicarb-
onate 5% in a suitable vehicle with a peppermint
flavour.
Dose
10–20 mL every 4 hours
1.4.2
Antimotility drugs
Antimotility drugs have a role in the management
of
uncomplicated
acute diarrhoea
in adults but
not
in
young children; see also section 1.4. However, in severe
cases, fluid and electrolyte replacement (section 9.2.1.2)
are of primary importance.
For
comments
on the role of
antimotility drugs
in
chronic bowel
disorders
see section 1.5.
For their role
in
stoma care
see section 1.8.
Loperamide can be used for faecal
incontinence [unli-
censed indication] after the underlying cause of incont-
inence has been addressed.
CODEINE PHOSPHATE
Indications
see notes above; cough suppression (sec-
tion 3.9.1);
pain (section 4.7.2)
Cautions
section 4.7.2;
tolerance and dependence
may occur with prolonged use;
interactions: Appen-
dix 1 (opioid analgesics)
Contra-indications
section 4.7.2;
also conditions
where inhibition of peristalsis should be avoided,
where abdominal distension develops,
or in acute
diarrhoeal conditions such as acute ulcerative colitis
or antibiotic-associated colitis
Hepatic impairment
section 4.7.2
Renal impairment
section 4.7.2
Pregnancy
section 4.7.2
Breast-feeding
section 4.7.2
Side-effects
section 4.7.2
Dose
. Acute diarrhoea,
ADULT
and
CHILD
over 12 years, 30 mg
3–4 times daily (range 15–60 mg)
Preparations
Section 4.7.2
CO-PHENOTROPE
A mixture of diphenoxylate hydrochloride and atro-
pine sulphate in the mass proportions 100 parts to 1
part respectively
Indications
adjunct to rehydration in acute diarrhoea
(but see notes above);
control of faecal consistency
after colostomy or ileostomy (section 1.8)
Cautions
section 4.7.2;
also young children are parti-
cularly susceptible to overdosage and symptoms may
be delayed and observation is needed for at least 48
hours after ingestion; presence of subclinical doses of
atropine may give rise to atropine side-effects in
susceptible individuals or in overdosage (section 1.2);
interactions: Appendix 1 (antimuscarinics,
opioid
analgesics)
Contra-indications
section 4.7.2 and also see under
Antimuscarinics (section 1.2)
Hepatic impairment
section 4.7.2;
also avoid in
jaundice
Renal impairment
section 4.7.2
Pregnancy
section 4.7.2 and also see under Atropine
Sulphate (section 1.2)
Breast-feeding
may be present in milk
Side-effects
section 4.7.2 and also see under Anti-
muscarinics (section 1.2);
also abdominal pain,
ano-
rexia,
and fever
Dose
. See preparations
Co-phenotrope
(Non-proprietary) A
Tablets
,
co-phenotrope 2.5/0.025 (diphenoxylate
hydrochloride 2.5 mg,
atropine sulphate 25 micr-
ograms),
net price 100 = £8.95
Brands include
Lomotil
c
Dose
initially 4 tablets, followed by 2 tablets every 6 hours until
diarrhoea controlled;
CHILD under 4 years see
BNF for Children
,
4–9 years 1 tablet 3 times daily, 9–12 years 1 tablet 4 times daily,
12–16 years 2 tablets 3 times daily,
but see also notes above
Note
Co-phenotrope 2.5/0.025 can be sold to the public for adults
and children over 16 years (provided packs do not contain more
than 20 tablets) as an adjunct to rehydration in acute diarrhoea
(max.
daily dose 10 tablets)
LOPERAMIDE HYDROCHLORIDE
Indications
symptomatic treatment of acute diarr-
hoea;
adjunct to rehydration in acute diarrhoea in
adults and children over 4 years (but see notes above);
chronic diarrhoea in adults only
Cautions
see notes above; interactions: Appendix 1
(loperamide)
Contra-indications
conditions where inhibition of
peristalsis should be avoided, where abdominal dis-
tension develops,
or in conditions such as active
ulcerative colitis or antibiotic-associated colitis
Hepatic impairment
risk of accumulation—manufac-
turer advises caution
Pregnancy
manufacturers advise avoid—no informa-
tion available
Breast-feeding
amount probably too small to be
harmful
Side-effects
abdominal cramps,
dizziness,
drowsi-
ness,
and skin reactions including urticaria;
paralytic
ileus and abdominal bloating also reported
Dose
. Acute diarrhoea, 4 mg initially followed by 2 mg after
each loose stool for up to 5 days; usual dose 6–8 mg
daily; max.
16 mg daily;
CHILD
under 4 years not
58
1.4.1 Adsorbents and bulk-forming drugs
BNF 61
1
Gastro-intestinal system