This document discusses anti-diarrheal drugs and provides information on their pharmacology. It defines diarrhea and describes the different types. The main causes and epidemiology of diarrhea are outlined. The pathophysiology involves changes in ion transport, motility, osmolarity and pressure. Signs and symptoms include frequent bowel movements. Treatment involves rehydration, nutrition therapy and antimicrobials when indicated. Loperamide is an opiate derivative that acts peripherally to inhibit chloride secretion. Adsorbents and bismuth subsalicylate provide symptomatic relief. Drugs used for inflammatory bowel disease include 5-aminosalicylic acid compounds, glucocorticoids, immunosuppressants and TNF-alpha

1. ANTI –DIARRHEAL DRUGS
Presented by :
RINKA JUNEJA
Department of PHARMACOLOGY
ISF college of pharmacy ,MOGA

2. Contents
• Defination
• Types of diahorrea
• Etiology of diahorrea
• Epidemiology of diahorrea
• Pathophysiology of diahorrea
• Sign & symptoms
• Pharmacology
• References

3. Definition
• Diarrhea is too frequent ,often too precipitate
passage of poorly formed stools.
• It is defined by WHO 3 or more loose or watery
stools in a 24 hour period.
• In pathological terms, it occurs due to the passage
of excess water in faces. It may due to
• Decreased electrolyte and
water absorption.
• Increased secretion by
intestinal mucosa.

4. Types of diahorrea
There are three clinical types of diarrhoea:
• acute watery diarrhoea – lasts several hours
or days, and includes cholera;
• acute bloody diarrhoea – also called
dysentery; and
• persistent diarrhoea – lasts 14 days or longer

5. Etiology of diarrhoea
• Diahorrea usually may symptom of
gastroenteritis an infection of bowl.
• It is caused by :
• Hepatitis virus
• CMV
• Rota virus
• Salmonella and shigella – food
poisoning

6. Epidemiology
• Diarrheal disease is the second leading cause of death in children under
five years old. It is both preventable and treatable.
• Each year diarrhoea kills around 525 000 children under five.
• A significant proportion of diarrhoeal disease can be prevented through
safe drinking-water and adequate sanitation and hygiene.
• Globally, there are nearly 1.7 billion cases of childhood diarrhoeal
disease every year.
• Diarrhea is a leading cause of malnutrition in children under five years
old.

7. 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.

9. Clinical presentation of diarrhoea
Signs and symptoms
• onset of nausea, vomiting, abdominal pain, headache, fever
• Bowel movements are frequent.
Laboratory tests
• Stool analysis studies include examination for
microorganisms,
• blood, mucus, fat, osmolality, pH, electrolyte and mineral
• concentration, and cultures.
• Stool test kits are useful for detecting gastrointestinal
viruses,(rotavirus).

10. Pharmacology
• Pharmacology of diarrhea mainly contain :-
1. Rehydration therapy
2. Nutrition therapy
3. Anti microbial therapy

11. Oral rehydration salts (WHO-ORS)
• Rehydration with ORS is usually sufficient for
management of moderate dehydration from
acute diarrhoea, 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 diarrhoea, thus
replacing the water and electrolytes lost in the
faces. A particular advantage of this is that ORS
may be used as home treatment to prevent
dehydration

13. Nutrition therapy
• Patients of 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 have diarrhea than some on the main nutrients
are lost : sodium ,potassium, water ,proteins, vitamins and
calories
.
• BLAND foods are given to the diahorrea patients.

14. Anti microbial therapy
• One or more antimicrobial agents is almost routinely
prescribed to most of the patients of diarrhea
• Such drugs have limited role in overall treatment of diarrheal
diseases, the reason are
• Bacterial pathogen is responsible
for only fraction of class.
• Anti microbial alter the course of
illness (bacterial diarrhoea)
• Anti microbial may prolong the
carrier site.

15. OPIATES AND THEIR DERIVATIVES
• Most opiates act through peripheral and
central mechanisms with the exception of
loperamide, which acts only peripherally
• Loperamide is antisecretory; it inhibits the
calcium-binding protein calmodulin,
controlling chloride secretion. Loperamide,
available as 2-mg capsules or 1 mg/5 mL
solution

16. ADSORBENTS
• Adsorbents are used for symptomatic relief.
These products, many not requiring a
prescription, are nontoxic, but their
effectiveness remains unproven.
• Adsorbents are nonspecific in their action;
they adsorb nutrients, toxins, drugs, and
digestive juices.

17. • Polycarbophil as an effective adsorbent
• Polycarbophil absorbs 60 times its weight in
water and can be used to treat both diarrhea
and constipation

18. ANTISECRETORY AGENTS
• Bismuth subsalicylate appears to have
antisecretory, anti-inflammatory, and
antibacterial effects
• As a nonprescription product, it is marketed for
indigestion, relieving abdominal cramps, and
controlling diarrhea, including traveler’s
diarrhea.
• .The usual adult dose is 2 tablets or 30 mL every
30 minutes to 1 hour up to 8 doses per day.

20. Inflammatory bowl disease
• It is the chronic or inflammatory disease of the
ileum, colon or both that associated with
systematic infestations
• It is idiopathic ,but occurs to have an important
immune component triggered by variety of
factors.
• Two major types of IBD: ulcerative colitis (uc)
and crohns’s disease.

21. Drugs for IBD
• Drug used in IBD are grouped as:
• 5 amino salicylic acid (ASA)
compounds
• Glucocorticoids
• Immunosuppressant's
• TNF alpha inhibitors

22. 5- ASA Compounds
• SULFASALAZINE
»Compound of 5-ASA with sulfa
pyridine linked through an azo bond
,and has specific therapeutic effect in
IBD.
»Poorly absorbed from ileum.
»It inhibits the both COX and LOX
decreased production
»Drug :- SULAZOPYRIN 0.5G TAB

23. Immunosuppressant
• Immunosuppressant play an important role in long term
management of IBD, Especially (CRD)
• About 60% patients with CRD and UC require
immunosuppressant therapy.
• Risk of chronic immunosuppressant must be weighted in
each patient .
Azathioprine
Methotrexate
TnFalpha inhibitor

24. TNFalpha inhibitors
o Infliximab :
oIt is chimera anti –TnF alpha
antibody indicated in sevre active
CrD and UC which has not
improved with I.V corticosteroids
and immuno suppressants
oInfused I.V every 2-8 weeks.

25. References
• Joseph T.Dipiro “Pharmacotherapy”, a
pathophysiological approach ,6 edition pg no
677-684.
• DuPont HL. Diarrheal diseases in the developing
world. Infect Dis clin North Am 1995;9:313–324.
• Everhart JE, ed. Digestive Disease in the United
States: Epidemiology and Impact. NIH Publication
94-1447. Bethesda, MD, National Institutes
Health, 1994.

26. • Thompsom RF, Bass DM, Hoffman SL. Travel
vaccine. Infect Dis Clin North Am
1999;13:149–167
• World Health Organization, http
www.WHO.int accessed on 11 April 2019.