Diarrhoea opiates

Loperamide is an opioid analogue that binds to the opiate gut receptors, thereby decreasing intestinal motility and increasing transit time. Loperamide is contraindicated in patients with active ulcerative colitis and children under 4 years. It is used in the treatment of diarrhoea. 

Opiates are the most effective non-specific agents, and the peripheral opiate agonist loperamide may be adequate in most individuals. Whilst giving such empirical treatment the possible need of fluid replacement must be remembered. Opiates are not replacements for oral rehydration fluids (based on salt and glucose) or intravenous rehydration fluids in acute diarrhoea. 

Symptom patterns those with alternating constipation and diarrhoea and predominant constipation may benefit from high fibre diets (although excess fibre may bloat). Those with predominant diarrhoea may require simple peripheral opiate agonists (loperamide), but may also be helped by raised fibre intake. Pain may respond in part to explanation that it does not indicate serious illness and in part to spasmolytic therapy with anticholinergic agents which... 

The opiates cause constipation by inducing spasm of the stomach and intestines, presumably by the stimulation of opioid receptors in the myenteric plexus and reducing the release of acetylcholine. This property can be used therapeutically for the symptomatic relief of diarrhoea. Biliary colic and severe epigastric pain can occur because of the contraction of the sphincter of Oddi and the resulting increase in pressure in the biliary ducts. 

Reduce the senna dosage to 1-2 tablets once daily initially (also check Mrs CR s current bowel habits if diarrhoea then senna should be stopped, ffowever, as Mrs CR will continue to receive opiate analgesia then it is likely that prophylactic laxative therapy will need to be continued, due to opiates causing constipation in almost all patients). Monitor Mrs CR s bowel habits during her inpatient stay in order to ensure the appropriateness of the laxative therapy. 

Roberts M C, Clarke L L, Johnson C M 1989 Castor-oil induced diarrhoea in ponies a model for acute colitis. Equine Veterinary Journal Supplement 7 60-67 Roelvink M E, Goossens L, Kalsbeek H C et al 1991 Analgesic and spasmolytic effects of dipyrone, hyoscine-/V-butylbromide and a combination of the two in ponies. Veterinary Record 129 378-380 Roger T, Bardon T, Ruckebusch Y 1985 Colonic motor responses in the pony relevance of colonic stimulation by opiate antagonists. American Journal of Veterinary Research 46 31-35... 

Some side-effects are not particularly serious. Some, in fact, can be advantageous. Euphoria, for example, is a useful side-effect when treating pain in terminally ill patients. Other side-effects, such as constipation, are uncomfortable but can give clues as to other possible uses for opiate-like structures. For example, opiate structures are widely used in cough medicines and the treatment of diarrhoea. 

Loperamide is an opiate drug that decreases motility of the intestine. It does not cross the blood-brain barrier easily and therefore does not have the central nervous system effects (euphoria, respiratory depression, nausea and vomiting and dependence) of other opiates. Loperamide is prescribed to counteract gastrointestinal side effects (diarrhoea) of therapeutic radiography. 

C. Diarrhoea. Diarrhoea is a common symptom in diabetic autonomic neuropathy. First line treatment includes a short course of antibiotics such as tetracycline or erythromycin. Opiate-like anti diarrhoeal agents like loperamide and codeine sulphate represents other first line treatments. Cholestyramine given with loperamide might be beneficial, and octreotide have shown to be effective as well. 

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