Lomotil (diphenoxylate with atropine). 2.5rag, 3 or 4 times daily as needed. It must be used cautiously in patients with advanced liver disease and in those who are addiction-prone or who are taking barbiturates.
Loperamide (imodium). 2mg 2 to 4 times daily is effective in acute and chronic diarrhea. Narcotics. Narcotics must be avoided in chronic diarrhea and are preferably avoided in acute diarrheas unless there is intractable diarrhea. Vomiting and colic always exclude the possibility of acute surgical abdominal disease before administering opiates. Any of the following drugs can be given:
Paregoric, 4 to 8ml after liquid movements as needed or with bismuth. Codeine phosphate. 15 to 65mg subcutaneously, if the patient is vomiting, after liquid bowel movements as needed. Strong opiates. Morphine and hydromorphone should be reserved for selected patients with severe acute diarrhea who fail to respond to more conservative meas-
ures.
Anticholinergic drugs, particularly when used in combination with sedatives, exert a mild antiperistaltic action in acute and chronic diarrheas associated with anxiety and tension states. It may be necessary to administer the various drugs to a point near toxicity in order to achieve the desired effect.
Antidiarrheal drugs must be used with great caution in inflammatory bowel disease and amebiasis because of the risk of "toxic" dilatation of the colon. Unless diarrhea is severe, they should be avoided in bacillary dysentery, since they prolong the carrier state.
Psychotherapy
Mlany cases of chronic diarrhea are of psychogenic origin. A survey of anxiety producing mechanism should be made in all patients with this complaint. Antidepres sant drug therapy may be useful, particularly since many of these agents have an anticholinergic effect.
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