This document discusses anti-diarrheal drugs used to treat different types of diarrhea. It defines diarrhea and describes its causes, symptoms, and pathophysiology. It discusses rehydration therapy using oral rehydration salts and nutrition therapy for diarrhea patients. The document outlines specific antimicrobials used to treat infectious diarrhea and probiotics to restore gut flora. Drugs used for inflammatory bowel disease like mesalazine, corticosteroids, immunosuppressants, and TNF-α inhibitors are mentioned. Finally, it discusses non-specific anti-diarrheal drugs that are absorbents, antisecretory, and antimotility agents like loperamide, diphenoxylate, and racecadotril.

1. ANTI - DIARRHEALS
BY- Sakshi Phaugat
Department - Mpharm (pharmacology) Ist year
Roll no. -2101700986008

2. DIARRHOEA
• Diarrhoea is too frequent, often too precipitate passage of poorly formed
stools.
• Diarrhoea is having 3 or more loose or liquid stools in one day, or more
frequently than normal.
• Diarrhoea episodes are often caused by a stomach bug ( gastroenteritis)and
clear up on their own in a few days.

3. DIARRHOEA(CONT’D)
• Acute Diarrhoea :
• Sudden onset in a previously healthy person
• Lasts from 3 days to 2 weeks
• Self-limiting
• Chronic diarrhoea:
• Lasts for more than 2 weeks
• Associated with the recurring passage of diarrheal stools ,fever , loss of appetite,
nausea, vomiting, weight loss, and chronic weakness.

4. SYMPTOMS
As well as the loose and watery stools of
diarrhoea, the other symptoms are also
occurs:
• Nausea
• vomiting
• Fever
• Headache
• Bloating and flatulence
• Abdominal cramps, with a colicky
pattern
• Stomach pains
• Loss of appetite
• Weakness
• dehydration

5. Causes of diarrhoea
• Acute diarrhoea
• Bacterial
• Viral
• Drug induced
• Nutritional
• protozoal
• Chronic diarrhoea
• Tumours
• Diabetes
• Addison’s disease
• Hyperthyroidism
• Irritable bowel

6. PATHOPHYSIOLOGY
• Four general pathophysiologic mechanisms disrupt water and electrolyte
balance, leading to diarrhea, and are the basis of diagnosis and therapy.
These are ( a) a change in active ion transport by either decreased sodium
absorption or increased chloride secretion ;
• (b) change in intestinal motility ; ( c ) increase in luminal osmolarity ;
• And (d ) increase in tissue hydrostatic pressure.

8. PHARMACOLOGY
• Pharmacology of diarrhea mainly contain :-
1. Rehydration therapy
2. Nutrition therapy
3. Drug therapy

9. ORAL REHYDRATION SALTS (WHO-
ORS)
• Rehydration with ORS is usually sufficient for management of moderate
dehydration from acute diarrhea, regardless of etiology, which can be safely
and effectively treated in over 90% of cases by the use of ORS. ORS is
absorbed in the small intestine even during diarrhea, thus replacing the water
and electrolytes lost in the feces
• A particular advantage of this is that ORS may be used as home treatment to
prevent dehydration.

10. NUTRITION THERAPY
• Patients with diarrhea should not be starved.
• Simple food like breast milk, boiled potato, rice, chicken soup, banana, etc.
should be given to the patient.
• When a patient has diarrhea then some of the main nutrients are lost:
sodium, potassium, water, proteins, vitamins, and calories.
• BLAND foods are given to the diarrhea patients.

11. Drug therapy
1. Specific antimicrobial
2. Probiotics
3. Drugs for IBD
4. Nonspecific antidiarrhoel

12. Antimicrobials – no value
• Irritable bowel syndrome
• Coeliac disease
• Pancreatic enzyme deficiency
• Topical sprue
• Thyrotoxicosis
• Rotavirus
• salmonella

13. Antimicrobials – useful (severe cases)
• Travellers diarrhoea – cotrimoxazole , norfloxacin, doxycycline, and
rifamixin.
• EPEC- cotrimazole, fluroquinolones
• Shigella enteritis – ciprofloxacin or norfloxacin , cotrimazole and ampicillin.
• Nontyphoid salmonella – FQs , cotrimoxazole or ampicillin
• Yersinia - cotrimoxazole

14. Antimicrobials – always useful
• Cholera – tetracycline , cotrimazole , FQs , ampicillin and erythromycin.
• Campylobacter jejuni- norfloxacin or erythromycin
• Clostridium difficile- metronidazole , vancomycin
• Amoebiasis and giardiasis – metronidazole , diloxanide furoate

15. Probiotics
• Live culture or lyophilized powders to restore and maintain gut flora.
• Recolonization of the gut by non- pathogenic , mostly lactic acid forming
bacteria.
• Probiotics significantly reduce antibiotic – associated diaarhoea , acute
infective diarrhoea and risk of travellers diarrhoea.
• Curd is an abundant source of lactic acid producing organisms.

16. Inflammatory bowel disease
• IBD is a chronic relapsing inflammatory disease of the ileum, colon, or both.
• crohn’s disease – lesions are patchy and transmural; may involve any part of
the g.i.t from mouth to the anus.
• Ulcerative colitis- it involves only the colon starting from the anal canal.

17. Drugs in IBD
• 5- aminosalicyclic acid compounds
• Corticosteroids
• Immunosuppressant
• TNF ά inhibitors

18. sulfasalazine
• 5ASA+sulfapyridine
• 5ASA inhibits COX, LOX decrease Pg and LT , cytokine,PAF, TNFά and
nuclear transcription factor
• Reduces frequency of stool , abdominal cramps and fever
• Used to maintain remission
• Sulfapyridine is responsible for rashes , fever , joint pain, haemolysis and
blood dyscrasias.

19. Mesalazine
• 5ASA delayed release preparation, release in jejunum, ileum, and colon.
• More useful in UC for remission.
• A/E- nausea, diarrhoea , abdominal pain and headache
• 5ASA - enema

20. Corticosteroids
• Prednisolone – induce remission in UC and CrD
• DOC for exacerbation
• Hydrocortisone enema for pro
• Used for short term and stopped after remission

21. Immunosuppressant
• Long term management , not suitable for acute exacerbation
• Azathioprine – steroid dependent, resistant and severe cases
• Methotrexate
• cyclosporine

22. TNFά inhibitors
• Severe active CrD ,fistulating CrD and severe UC not responding to steroids
or immunosuppressant
• Infliximab
• Adalimumab
• A/E- acute reactions, immune reactions and lowering of resistance to
infection

23. Non specific drugs
• Absorbents and adsorbents
• Antisecretory
• antimotility

24. Absorbants and adsorbants
• Bulk forming isaphghula , methylcellulose , carboxymethyl cellulose
• Diarrhoea phase of IBD
• Modify consistency and frequency,
• No effect on loss of water and electrolyte

25. Anti secretory- racecadotril
• Prodrug of thiorphan
• Prevent degradation of enkephalins of δ opoid receptor
• Decreases hypersecretion without affecting motility
• Short term treatment of secretory diarrhoea
• Safely given in children

26. Anti motility drugs
• μ receptors enhance absorption and decrease propulsive movements
• δ receptors promote absorption and inhibit secretion
• Increase resistance to luminal transit and allow more time for the absorptive
processes
• Only symptomatic relief in diarrhoea

27. Diphenoxylate
• Synthetic opoid
• Absorbed systemically and crosses BBB
• Atropine added in sub pharmaceutical doses to discourage abuse
• A/E – respiratory depression , paralytic ileus and toxic megacolon
• Contraindicated in <6 years

28. Loperamide
• Opiate analogue with μ agonistic and some weak anticholinergic effect
• Less absorbed from intestine – less BBB crossing
• Longer duration action than codeine and diphenoxylate
• Decrease motility and inhibit secretion
• A/E – abdominal cramps , rashes , paralytic ileus, toxic megacolon
• CI < 4 years

29. Antimotility drugs
• Useful in non infective , mild travellers diarrhoea and when diarrhoea is
exhausting in AIDS
• CI in infective diarrhoea , severe IBD
• Induce delibrate short term constipation – after anal surgery

30. New drugs
• The US FDA approved AEMCOLO ( RIFAMYCIN) an antibacterial drug
indicated for the treatment of adult patients with travellers diarrhea caused
by noninvasive strains of E.coli .

31. References
• Joseph T. dipiro ‘’ pharmacotherapy’’ , a pathophysiological approach ,6
edition.
• Essentials of medical pharmacology ,K.D Tripathi
• World Health Organization , http www.WHO.int accessed on 18 June
2022