. 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.
