Opiates are usually the first-line therapy for most mild to moderate diarrheas. Commonly used preparations include paregoric, tincture of opium, codeine, Lomotil (diphenoxylate with atropine), Imodium (loperamide), and difenoxin with atropine. These agents inhibit transit throughout the gastrointestinal (GI) tract; therefore, they increase the contact time between intestinal luminal contents and the mucosa, increasing absorption. Experimentally, opiates have proab-sorptive and antisecretory effects, but it is unclear if these mechanisms are operative in humans. Synthetic opioids such as Lomotil (2.5 mg diphenoxylate plus 25 |g atropine per tablet) and loperamide (Imodium) (2 mg/tablet) have fewer central nervous system (CNS) side effects than morphine. The recommended doses are as follows:

1. Loperamide, 2 to 4 mg 4 times daily

2. Diphenyloxylate plus atropine, 1 to 2 tablets 4 times daily

3. Codeine, 30 to 60 mg 4 times daily

4. Paregoric (0.4 mg morphine/mL), 5 to 10 mL 4 times daily

5. Tincture of opium (10 mg morphine/mL), 5 to 20 drops 4 times daily

All of these drugs except loperamide are controlled substances because of their potential for misuse or addiction. At high doses, Lomotil can also cause CNS side effects, whereas loperamide, because it does not cross the blood-brain barrier as efficiently, has fewer side effects at higher doses.

The main side effects from the use of opiates are abdominal discomfort, constipation, nausea, vomiting, and CNS symptoms (drowsiness, respiratory depression, and altered mental status). Lomotil, because of the presence of atropine, can cause anticholinergic side effects. Physical dependence can occur with prolonged use, although it is reduced with Lomotil by combining the diphenoxylate with atropine.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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