Yoga and Healing
Aruna Bakhru in Nutrition and Integrative Medicine, 2018
An alternative study was performed to evaluate the fundamental effect of yogic and conventional treatment in diarrhea-predominant IBS in a randomized control plan. There were 22 participating males, ages 20–50 years, with a confirmed diagnosis of diarrhea-predominant IBS. The conventional group received symptomatic treatment with loperamide 2–6 mg/day for two months. In contrast, the yogic intervention group performed a set of 12 asanas or yogic poses (including Vajrasana, Shashankasana, Ushtrasana, Marjariasana, Padhastasana, Dhanurasana, Trikonasana in two variations, Pawanmuktasana, and Paschimottanasana) along with Surya Nadi pranayama (right-nostril breathing) two times a day for 2 months. All participants were tested at three proportional intervals, at the beginning of the study—0 month, 1 month, and 2 months of receiving the intervention. The subjects were examined for bowel symptoms, autonomic symptoms, autonomic reactivity, surface electrogastrography, and anxiety profile by Spielberger's Self Evaluation Questionnaire, which assessed trait and state anxiety (Taneja et al., 2004).
Introduction to bowel management
Victoria A. Lane, Richard J. Wood, Carlos A. Reck-Burneo, Marc A. Levitt in Pediatric Colorectal and Pelvic Surgery, 2017
Loperamide is an opioid receptor agonist and acts on the μ-opioid receptors in the myenteric plexus of the intestine, but does not affect the central nervous system. The mechanism of action is to reduce the activity of the myenteric plexus, which in turn decreases the tone of the circular and longitudinal smooth muscles of the intestinal wall, thus increasing the time that the digested material remains in the large intestine, allowing for more water to be reabsorbed. Loperamide also suppresses gastrocolic reflex, thereby decreasing colonic mass movements.Diphenoxylate and atropine combinations (e.g., Lomotil). Diphenoxylate is an opioid agonist and acts as an anti-diarrheal agent by slowing intestinal contractions and peristalsis (atropine is added to prevent overdose as this causes tachycardia).
Practice Paper 8: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
Irritable bowel syndrome is a functional disease which presents with abdominal bloating, cramps and alternating bowel habit (constipation/diarrhoea). When considering the diagnosis of irritable bowel syndrome, it is important to exclude organic bowel disease such as coeliac disease and colorectal cancer. If the patient is over 50 years of age and displays any ‘red flag’ symptoms such as weight loss or rectal bleeding, they should be referred for further investigation. Otherwise, it would be prudent to assess the patient’s full blood count, urea and electrolytes, thyroid function, anti-endomyseal antibodies, and do a stool culture to rule out electrolyte imbalance, thyroid disease, coeliac disease and infective causes. If investigation reveals no cause, the patient should be advised to eat a healthy diet with a high fibre content. Antispasmodic medications such as mebeverine hydrochloride or peppermint capsules may provide symptomatic relief. In diarrhoea-prominent disease, loperamide may be used to reduce the frequency of bowel motions (provided that an infective cause has been excluded). In constipation-predominant disease, stool-bulking agents such as methylcellulose may improve symptoms. If no improvement is made with treatment, the patient should be reassessed for an organic cause.
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].
Related Knowledge Centers
- Constipation
- Dysentery
- Inflammatory Bowel Disease
- Irritable Bowel Syndrome
- Short Bowel Syndrome
- Toxic Megacolon
- Diarrhea
- Pregnancy
- Opioid
- Breastfeeding