The Use of Antidiarrheal Medication

• Understand the difference between opioid-related medications for diarrhea and those that have the combination of kaolin and pectin.
• Be aware of the adverse effects of these medications to mitigate symptoms when they appear.
• How nurses can play a role in the assessment and education of patients needing antidiarrheal medication.

Antidiarrheal medication plays an essential role in controlling diarrhea (loose stools) and they are typically given when diarrhea becomes severe and persistent.  Antidiarrheal medications may act systemically or locally.

Over-the-counter antidiarrheal medications are found in most drug stores and some are only available by prescription.  They are typically used for acute situations such as viral gastroenteritis.  It is important to note that taking an antidiarrheal medication does not normally treat the underlying cause, but they may help with discomfort that comes from watery loose stools.

For most individuals, diarrhea only occurs a few times per year and goes away on its own.  In cases such as these, antidiarrheal medications are more than likely not necessary.  For individuals that experience digestive diseases such as inflammatory bowel syndrome (IBS) it is important for these individuals to consult with their doctor first to determine if antidiarrheal medications would be harmful or helpful to certain types of IBS.

Opioid-Related Medications

Opioid-related medications lower the progressive and involuntary peristalsis movements that push fecal matter along the intestine.  Examples of these include:

• Diphenoxylate with atropine
• Loperamide

Diphenoxylate with atropine is absorbed readily in the gastrointestinal tract; however, loperamide is not well absorbed after oral administration.  Both medications are distributed in the serum, metabolized in the liver, and excreted primarily in feces.

They act by slowing down gastrointestinal motility due to depression of the circular and longitudinal muscle action or peristalsis in the large and small intestines.  In addition, they decrease expulsive contractions throughout the colon.

Diphenoxylate with atropine and loperamide can interact with the following drugs and enhance the depressant effects:

• Barbiturates
• Alcohol
• Opioids
• Tranquilizers
• Sedatives

Kaolin and Pectin Medications

Kaolin and pectin mixtures are locally acting and are considered a type of over-the-counter antidiarrheal medication.  They work by adsorbing any irritating substances and soothing the intestinal mucosa.

The mixture of kaolin and pectin is not absorbed orally and does not get distributed throughout the body.  However, it is excreted in the feces.

Kaolin and pectin are adsorbents that bind with bacteria, toxins, and other irritants in the intestinal mucosa.  Pectin works by decreasing the pH in the intestinal lumen and provides a soothing effect on irritated mucosa.

Kaolin and pectin are useful in relieving mild to moderate acute diarrhea and can be used when the exact cause of diarrhea is unknown.

It is important to keep in mind that kaolin and pectin can hinder the absorption of digoxin and other drugs in the intestinal lumen when given simultaneously; therefore changing the timing of certain medications and not giving at the same time is of utmost importance.

Overall, kaolin and pectin are well tolerated but they can sometimes cause constipation in the elderly and other debilitated patients.

Adverse reactions

The following are important to note when observing individuals that use antidiarrheal medications:

• Nausea and vomiting
• Abdominal discomfort or distention
• Drowsiness and fatigue
• Central nervous system depression
• Tachycardia
• Paralytic ileus – absent or reduced peristaltic movements in the intestine

Nurse’s Role and Patient Education

It is important for nurses to understand the vital role they play in the administration and management of antidiarrheal medication and the important areas that must be considered.

The following nursing processes are appropriate for patients receiving antidiarrheal medications.

Assessment

• Before starting the medications, monitor the patient’s health status and diarrhea.
• Check the patient’s electrolyte and fluid balance.
• Monitor the patient’s hydration status if adverse gastrointestinal reactions occur.
• Evaluate the patient for adverse drug reactions.
• Assess the patient and his/her family member’s knowledge of the medication therapy.

Key Nursing Diagnoses

• Diarrhea related to the underlying condition
• Risk for fluid volume deficit related to gastrointestinal adverse effects
• Knowledge deficit related to medication therapy

Planning Outcome Goals

• The patient will have decreased episodes of diarrhea with normal bowel movements.
• The patient will maintain adequate fluid and electrolyte balance as evidenced by serum electrolyte levels, fluid intake, and output.
• The patient and his/her family members will have a better understanding of the medication regimen.

Evaluation

• The patient’s diarrhea is relieved and adequate hydration is maintained.
• The patient has normal fluid and electrolyte levels, intake, and output.
• The patient and his/her family members have a better understanding of the medication regimen.

Patient Teaching

The following points are important to teach the patient and his/her family members regarding antidiarrheal therapy:

• Take the drug exactly as prescribed. Do not take more than the recommended doses as it can lead to dependence.
• Report to the healthcare provider if diarrhea lasts more than 2 days, if the antidiarrheals are ineffective, or if any acute symptoms of abdominal discomfort are present.
• Avoid doing activities that require mental alertness such as driving or operating machinery, since central nervous system depression can occur.
• Be certain to maintain an adequate fluid and electrolyte intake. Drink at least 2 to 3 liters of water per day.
• Rest if persistent episodes of diarrhea are present.
• Avoid consuming foods and fluids that irritate the gastrointestinal tract especially in the presence of diarrhea.
• Eat foods rich in fiber as it can help prevent diarrhea and normalize bowel movements.

The Bottom Line

Antidiarrheal medication is given for acute and persistent diarrhea and can be useful for individuals that experience episodes of diarrhea.  For those individuals that have other underlying conditions or IBS, other prescribed medications may prove to be more effective and can be used for long term usage versus over-the-counter antidiarrheal medications.

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