1.4 Acute diarrhoea

1.4.2 Antimotility drugs

Fluid and electrolyte repletion is the primary treatment for acute diarrhoea and gastroenteritis.

For details of oral rehydration see 9.2.1 Oral preparations for fluid and electrolyte imbalance.

A diagnosis of the cause of diarrhoea should be made before starting symptomatic treatment. Acute prescriptions should be restricted to 30 loperamide capsules or 20 codeine tablets.

NICE CG49 (2007) addresses the management of faecal incontinence. Prescribers are advised to review patient's medication and consider alternatives to drugs that might be contributing to faecal incontinence.

For advice about the use of antibiotics in gastroenteritis, refer to Gastro-intestinal tract infections in chapter 5 of the formulary.

Many of these products are cheap to buy and are readily available, along with advice, from pharmacies. Some self-care medicines are available in shops and supermarkets. Please click here for further information and a patient leaflet.

Loperamide
  • Capsules 2mg (£1.01 = 30 capsules)
  • Oral SyrupSF 1mg/5ml (£1.17 = 100ml)

Indications

  • Acute diarrhoea
  • Chronic diarrhoea

Dose

  • Acute diarrhoea: 4mg initially followed by 2mg after each loose stool (maximum 16mg in 24 hours)
  • Chronic diarrhoea: 4mg-8mg per day in divided doses, adjust to symptoms (maximum 16mg in 24 hours)

Notes

  1. For chronic diarrhoea, loperamide should be introduced at a very low dose and the dose should be escalated, as tolerated by the individual to achieve the desired stool consistency.
  2. Loperamide syrup is a treatment option for chronic diarrhoea for use in dose titration and where a patient's regular dose remains under 2mg.
Codeine phosphate

Indications

  • Acute diarrhoea
  • Chronic diarrhoea

Dose

  • Acute diarrhoea: 30mg 3-4 times daily (range 15–60mg)

 

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