[MOL] Diarrhea.... [01484] Medicine On Line

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[MOL] Diarrhea....

.  Diarrhea

Several anti-cancer drugs can damage the digestive tract, at times leading to diarrhea. Specific drugs particularly associated with diarrhea are 5-FU, methotrexate, cytarabine, capecitabine and irinotecan. Because it is difficult to predict which patients will develop diarrhea, prevention is not an effective management strategy and antidiarrheal therapy is the mainstay of treatment. In addition, adequate fluid intake is critical in order to prevent dehydration. Drinking water, soup or non-caffeinated beverage is adequate in mild diarrhea, and oral fluid replacement preparation (such as Gatorade) is preferable in moderate losses. Intravenous fluid support might be required in a severe case of dehydration. Diarrhea can be controlled with Lomotil or Imodium, unless the diarrhea is caused by infection.

Drug name Usual dose Side effects
Water, broth, soda 8 to 10 glasses daily No coffee or caffeine-containing liquids, as they can worsen diarrhea
Rehydration formulas As indicated Well tolerated
Loperamide (Imodium) 2 capsules followed by 1 capsule after each loose stool, up to 8 capsules per day Sedation, drowsiness
Lomotil 1 or 2 tablets 3 to 4 times per day Nervousness, drowsiness

Diarrhea caused by irinotecan is treated in a different manner. If diarrhea occurs less than 24 hours after the infusion, atropine is given to control the symptoms. For late-onset diarrhea (more than 24 hours after infusion), the patient should take 2 caplets of loperamide (4mg) after the first episode of loose stools, followed by one caplet (2mg) every 2 hours until diarrhea-free for 12 hours. During nighttime, the patient should take 2 caplets (4mg) every 4 hours.

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