Antidiarrhoeal agent

1. Dr.Jannatul Ferdoush Assistant Professor Department Of Pharmacology ANTIDIARRHOEAL AGENT

2. Diarrhoea Diarrhoea is a frequent passage of liquid feces resulting from an imbalance between secretion & reabsorption of fluid & eletrolites . Causes: 1 .Infective 2.gut motility disorder. 3.IBS & malabsorption due to disease. 4.secretory tumour of GIT- carcinoid tumour & vipoma .

3. TREATMENT APPROACHES O F DIARRHOEA 1.For mild to moderate diarrhoea Maintenance of fluid and electrolyte balance . 2.For severe acute diarrhoea Maintenance of fluid and electrolyte balance. Antimotility & antispasmotic drug. antiinfective agents.

4. FLUID AND ElECTROLITE TREATMENT Oral rehydration therapy with glucose- electrolite solution to maintain the fluid & electrolite balance is the first priority. Composition of Oral rehydration salt: Na 75mmol/l Cl 69mmol/l Glucose 75mmol/l K 20mmol/l Citrate 10mmol/l Advantages: Simple,effective,cheap,readily administered therapy for a potentially fatal condition. Hypotonic solution, so can cause more Na and water retension .

5. ANTIDIARRHOEAL AGENTS Antimotility drug— opioid agonist Antispasmotic drug— M-R antagonist Direct acting muscle relaxant Antiinfective agent— Erythromycin,ciprofloxacin . Adsorbent— kaolin,pectin,charcoal,methylcellulose . Octreotides

6. ANTIMOTILITY DRUGS Opioid agonist— loperamide Diphenoxylate codeine Role in GIT motility— tone & rythmic contraction of the intestine. propulsive activity. tone of the large intestine. secretion of intestine. All sphincter are contracted.

7. OPIOID AGONISTS Advantages: Cannot cross the blood brain barrier, so use only for their action on GIT. Disadvantages: Constipation,abdominal cramp,drowsiness,dizziness . Large dose Diphenoxylate produces typical opoid effect. So small dose of Atropine is used in combination to discourage overdose. Contraindication: Acute diarrhoea in children—cross BBB—respiratory depression. IBS—toxic dilatation of the colon.

8. ANTISPASMODIC AGENTS M-R antagonist— Atropine hyoscine propantheline dicycloverine Role in GIT: Inhibit M-R in the enteric nerve plexus & on smooth muscle. Inhibit parasympathetic activity. Decreases spasm of intestine.

9. ANTISPASMODIC AGENTS Direct acting muscle relaxant: Mebeverine —derivatives of reserpine. Role in GIT: direct relaxation action on smooth muscle of intestine.

10. Antiinfective agents D iarrhoea Mostly viral in origin— No antibiotic required. Only fluid & electrolite replacement. Bacterial origin---mostly campylobacter species Rx– erythromycin or ciprofloxacin. Travellers diarrhoea : E.coli common. Rx—no antibiotic required. Only fluid & electrolite replacement

11. OCTREOTIDES Octreotides :synthetic analogue of somatostatin . Role in GIT: It enhances Intestinal fluid secretion. slows GIT motility in high doses. Use: after vagotomy . AIDS . Disadvantages: steatorrhoea leads to deficiency of fat soluble vitamins. Alteration of GIT motility causes nausea, abdominal pain,flatulence .

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