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GI Disorders
IBS, IBD, Constipation, Diarrhea
| Drug | Important & Special Dosing | Onset of Action - Constipation | Preferred | DO NOT USE | Special administration/DDI | Regard to Meals | Limitations |
|---|---|---|---|---|---|---|---|
| alosetron (Lotronex) | restricted use program | IBS-D; women with severe symptoms not relieved by conventional therapy | severe liver impairment | BBW: severe constipation, ischemic colitis | |||
| diphenoxylate-atropine (Lomotil) | QID until improvement then decrease dose (MAX 20mg-0.2mg/d x 10 days) peds ½ dose | infectious diarrhea; glaucoma; CVD; obstructive uropathy | avoid with azelastine, ipratropium, MAOIs, K+, CNS depressants | ||||
| benzocaine | No internal use | ||||||
| bisacodyl (Dulcolax) | 5-15 mg PO daily, 10 mg PR | Within 8-12 hours | adults | pediatrics | do not take with antacids; separate | avoid long-term use (malabsorption) | |
| bismuth subsalicylate (Pepto‑Bismol) | 524 mg Q30-60 mins for max of 48 hours (MAX 4800 mg/d) | adults | pregnancy, breastfeeding, pediatrics with chicken pox/flu (Reye's syndrome); h/o GI bleed | increases toxicities: warfarin, methotrexate; decreases efficacy of TCN, FQs; bleeding risk w/anticoags | |||
| dicyclomine (Bentyl) | 20 mg PO QID x 7 days then 40 mg QID | IBS-C, IBS-D | severe liver impairment, CHF, renal dysfunction, obstructive GI diseases, ulcerative colitis | D/C if 2 weeks w/o improvement | |||
| PT/exercises | pelvic floor dysfunction | ||||||
| docusate (Colace) | 100 mg PO BID | Within 3 days | adults | < 2 yr old (benzyl alcohol toxicity) | part of mush n push combo | ||
| eluxadoline | BID; lower dose if renal/hepatic impairment, lack tolerability | severe liver impairment, lack of gallbladder, >3 alcoholic drinks/day | D/C if pancreatitis, sphincter of Oddi spasm, biliary duct obstruction | food & water | CNS depression | ||
| hyoscyamine (Levsin) | q6 hrs, max 1.5 mg/day | severe liver impairment, CHF, renal dysfunction | 30 – 60 mins before meals | ||||
| Lactitol | Within 3 days | galactosemia | separate from other meds by 2 hrs | ||||
| lactulose (Constulose) | Within 1-6 hours | cirrhotic patients for hepatic encephalopathy | mix w/drink for PO; dilute w/water or NS for enema | electrolyte imbalances | |||
| linaclotide (Linzess) | IBS-C | pediatrics: severe dehydration and GI obstruction | take 30 min before first meal | empty stomach | D/C if 4 weeks w/o improvement | ||
| loperamide (Imodium) | 4mg --> 2mg/stool (MAX 16 mg/day) x 48 hrs; Peds: ½ dose (9-11y.o MAX 6mg/d; 6-8y.o MAX 4mg/d) | episodic management of urgent diarrhea (IBS-D) | Infectious diarrhea | ||||
| lubiprostone (Amitiza) | lower dosing in severe liver impairment | IBS-C (adult females); use if patient fails other agents due to high cost and less evidence | GI obstruction; severe diarrhea | BID | food & water | ||
| magnesium hydroxide (MgOH) (Milk of Magnesia) | within 1 - 3 hours | pregnancy, renal dysfunction, CHF, <2yo | maintain hydration | electrolyte imbalances | |||
| methylnaltrexone (Relistor) | weight-based, renal, hepatic dosing | palliative care & OIC | suspected obstruction | SQ QOD or SQ PO daily | empty stomach w/water > 30 mins before first meal | ||
| mineral oil | 14 - 45 mL PO once daily (adults) | within 6 - 8 hrs | older than 6 yrs | bedridden patients | avoid HS admin | NOT for long-term use (nutritional deficiencies) | |
| polyethylene glycol (PEG, Miralax, GoLytely) | 17 g PO Qday | within 1 - 3 days | non-IBS constipation; off-label IBS-C (weak) | mechanical GI obstruction, galactosemia | separate from other meds by 2 hrs | use in beverage with a meal | Don’t use for >1-2 weeks |
| naloxegol (Movantik) | Severe Liver Impairment (½ dose if CrCl <60) | OIC treatment | Suspected obstruction; severe liver impairment; strong CYP3A4 inhibitors | empty stomach | less effective if using opioids for < 4 weeks | ||
| naldemedine (Symproic) | OIC treatment | Suspected obstruction; severe liver impairment | without regard to meals | less effective if using opioids for < 4 weeks | |||
| NaPhos (sodium phosphate) | pregnancy, renal dysfunction, CHF, caution in <2yo | Monitor electrolytes, keep hydrated | |||||
| Phenylephrine | NO internal (PR) use in HTN, DM, BPH, thyroid/heart disease, depression | ||||||
| plecanatide (Trulance) | Trulance | IBS-C | pediatrics: severe dehydration and GI obstruction | use alternative if >4wks w/o improvement | |||
| psyllium (Metamucil) | gradually increase | Within 3 days | elderly, pregnancy | pelvic floor dysfunction; OIC | separate from other meds by 1 - 2 hrs | take with fluids | |
| methylnaltrexone (Relistor) | OIC treatment | ||||||
| senna (Ex-Lax, Senokot) | 17.2 mg PO Qday | Within 8-12 hours | adults | pediatrics | avoid long-term use (malabsorption) | ||
| sodium phosphate (NaPhos) (Fleet enema) | within 1 - 3 hours | pregnancy, renal dysfunction, CHF, <2yo | maintain hydration | electrolyte imbalances | |||
| tenapanor (Ibsrela) | IBS-C | pediatrics (severe diarrhea), GI obstruction | immediately before breakfast/dinner | D/C if severe diarrhea | |||
| colestipol, cholestyramine | diarrhea, IBS-D | monitor for DDIs: vitamins, NSAIDs, amiodarone, oral contraceptives, diuretics | |||||
| octreotide | cirrhotic patients | ||||||
| rifaximin (Xifaxan) | TID x2weeks; repeat up to 2 times prn | traveler’s diarrhea and cirrhosis |
Created by:
CaristW