|
Medication Class |
Examples |
Principal indication |
Side Effects and Comments |
|
Antispasmodics |
Donnatol (belladonna/phenobarbital) Bentyl (Dicyclomine
hydrochloride), Levsin/Levbid (Hyoscyamine sulfate) |
Pain and diarrhea |
Dry mouth and eyes, urinary retention, tachycardia, drowsiness.
Can be mildly constipating. |
|
Antidiarrheals |
Immodium, Kaopectate, and Maalox (all Loperamide); Lomotil (diphenoxylate
and atropine sulfate), Pepto Bismol (bismuth subsalicylate) |
Diarrhea,
urgency, incontinence |
Considerable variation in required dose; can induce
constipation, drowsiness and/or dizziness.
|
|
Tranquilizer/anti-spasmodic |
Librax (Chlordiazepoxide hydrochloride, Clidinium bromide)
|
Pain, diarrhea |
Blurred vision, drowsiness, can be habit-forming. |
|
Tricyclic antidepressants |
Secondary
amines (e.g., nortriptyline,
desipramine) |
Pain, diarrhea, other discomforts |
Fewer CNS and anticholinergic side effects and less sedation,
orthostatic hypotension & weight gain with secondary amines;
start low and work up to target dosage. Constipation can worsen. |
|
Tertiary
amines
(e.g., amitriptyline,
imipramine) |
|
Narcotic Analgesics
|
Vicodin (Hydrocodone), Percodan and Percocet (Oxycodone),
Demerol (Meperidine), Codeine, Morphine. |
Pain, diarrhea |
Drowsiness, dizziness, constipation, nausea. Can be
habit-forming. Possible dangerous interactions with other
prescription and over-the-counter drugs, and alcohol. |
|
Newer antidepressants |
SSRIs (e.g., fluoxetine, paroxetine) |
Can be used for pain
management and constipation in patients who are intolerant
to TCAs |
Transient exacerbation of nausea; diarrhea can occur with SSRIs;
sleep disruption occurs with some agents |
|
Others
(e.g., buproprion, venlafaxine) |
|
5-HT3 antagonist
|
Alosetron (LOTRONEX) |
Affects multiple symptoms in diarrhea-predominant female
patients only, including pain,
urgency, and diarrhea.
|
May cause severe constipation and ischemic colitis. Effectiveness has not been shown in men. Lotronex was withdrawn from the U.S. market November 2000 then reintroduced under stringent prescribing guidelines.
|
|
5-HT4 antagonist
|
Tegaserod (ZELNORM) |
Pain and constipation in constipation-
predominant female patients
|
Approved for short-term use only. Approved for women only. May cause diarrhea, bloating, pain.
|
|
Under Investigation |
Cilansetron
|
5-HT3 antagonist |
Under investigation by Solvay Pharmaceutical for chronic
diarrhea |
|
Prucalopride |
5-HT4 receptor |
Under investigation by Janssen Research Foundation for chronic
constipation |
