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Behavioural approaches to managing substance-related problems in gastrointestinal conditions
Published in Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus, Psychogastroenterology for Adults, 2019
In addition to NBS, reasons to consider tapering opioids include a lack of a clinically meaningful improvement in pain or functioning; severe adverse effects, including worsening psychiatric symptoms; violation of the patient-provider opioid agreement; and opioid misuse or abuse. Addressing symptoms of withdrawal is critical to prevent anxiety/fear reactions which can make patients hesitant to taper further. Alpha-adrenergic agents such as clonidine can reduce sympathetic nervous system symptoms, but patients must be monitored for anticholinergic side effects. Small doses of loperamide can be used to treat diarrhoea. Trazadone and combined buprenorphine/naloxone can also be used to treat withdrawal (www.agency.meddirectors.wa.gov/guidelines.asp). Adjunctive behavioural techniques to address catastrophising, muscle tension, and reverse autonomic arousal by relaxation training and breath retraining show efficacy in reducing the manifestations of anxiety in GI cohorts.
Faecal Incontinence
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
P. Ronan O’Connell, Thomas Dudding
For those patients with loose, urgent stool (Bristol type 5, 6 or 7), treatment in addition to dietary modification is to introduce constipating agents, such as loperamide, codeine phosphate or co-phenotrope (Lomotil®), (diphenoxylate hydrochloride and atropine sulphate).72,74,75 Loperamide is particularly useful because of its low side effect profile; however, some patients may become quite constipated when taking the adult dose (2 mg), in which case use of paediatric syrup allows titration of lower doses. Co-phenotrope may cause a dry mouth, tachycardia and nystagmus, and, as with loperamide, use of the liquid preparation is particularly helpful in establishing an effective dose. Other preparations such as kaolin may be of benefit and should be considered if first-line drugs fail. It is not advisable, however, to prescribe agents containing morphine or opium if prolonged treatment is contemplated. Bulking agents, such as ispaghula (Isogel®) or methylcellulose, may improve the consistency of a liquid stool. Alternative bulking agents include psyllium (Metamucil®, Citrucel®), calcium polycarbophil (Konsyl®), sterculia (Inolaxine®) or ceratonia with starch (Arobon®). In patients with intestinal hurry due to terminal ileal resection it is worth trying a course of a bile salt chelating agent such as cholestyramine (Questran®).
Information on level of drugs into breastmilk
Published in Wendy Jones, Breastfeeding and Medication, 2018
Loperamide provides symptomatic relief of diarrhoea by inhibiting gut motility. Only small amounts are found in breastmilk as it is poorly absorbed (Nikodem and Hofmeyr 1992) making this a suitable drug to be taken by a breastfeeding mother. It is licenced to be given to children over the age of 4 years in syrup formulation at a dose of 1 mg three or four times daily for a maximum of three days.
Tackling metastatic triple-negative breast cancer with sacituzumab govitecan
Published in Expert Review of Anticancer Therapy, 2021
Anna R Schreiber, Michelle Andress, Jennifer R Diamond
Grade 1–4 neutropenia was present in 64% of patient mTNBC in the Phase I/II trial, though febrile neutropenia only occurred in 8% of patients [40]. It is highly recommended that patients experiencing grade 3 or 4 neutropenia receive granulocyte colony stimulating factor (G-CSF). In addition, diarrhea occurred in 63% of mTNBC patients, however grade 3 or 4 diarrhea was rare occurring in only 9% of patients [40]. For patients experiencing diarrhea, loperamide may be used. In patients with excessive cholinergic reactions or early diarrhea, atropine premedication can be considered. Both neutropenia and diarrhea are FDA boxed warnings and should be monitored. Alopecia is another adverse event that has been noted with sacituzumab govitecan, though this is expected. Longer-term efficacy of scalp cooling for drug-induced alopecia needs to be explored [41,42].
The safety of available treatment options for short bowel syndrome and unmet needs
Published in Expert Opinion on Drug Safety, 2021
Loris Pironi, Emanuel Raschi, Anna Simona Sasdelli
Many prokinetic drugs carry a small but increased risk of drug‐induced arrhythmia, and cisapride (a non‐selective 5‐HT4 receptor agonist which also acts as a 5‐HT2 and 5‐HT3 receptor antagonist) was withdrawn worldwide for its TdP liability [33]. Among dopaminergic agents, domperidone received regulatory restriction for TdP liability as compared to metoclopramide. As regards serotonin agonists, a recent real-world multinational cohort study confirmed that prucalopride possesses a favorable cardiovascular safety profile by virtue of its 5-HT4 selectivity with low hERG blockade potency [34]. Loperamide is a synthetic opioid used as over the counter drug to treat diarrhea and is thought to present a low risk of abuse because of poor penetration of the central nervous system. However, cases of TdP have been described during the opioid crisis, following overdoses when combined with a P-glycoprotein inhibitor, also considering that loperamide is an extraordinarily potent hERG blocker [35,36].
Advances in non-surgical treatment for pediatric patients with short bowel syndrome
Published in Expert Opinion on Orphan Drugs, 2020
Danielle Wendel, Beatrice E. Ho, Tanyaporn Kaenkumchorn, Simon P. Horslen
Anti-motility agents are the most commonly used medications for diarrhea increasing intestinal transit time to optimize absorption. Loperamide is a mu opioid receptor agonist that slows intestinal motility but does not result in the same neurologic effects of sedation, addiction, or euphoria as opioids [100]. It acts on the intestinal muscles to inhibit peristalsis, reduce fecal volume, increase viscosity and diminish fluid and electrolyte loss [86]. Loperamide has been associated with necrotizing enterocolitis and should be used with caution in younger patients [103]. Overall, loperamide is generally safe and commonly used to treat intestinal failure associated diarrhea although many patients with intestinal failure will require greater than maximum dosages due to decreased intestinal absorption [100].