Medications that cause diarrhea
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Medications That Cause Diarrhea: An Overview
Common Medications Leading to Diarrhea
Antibiotics and Antimicrobials
Antibiotics are one of the most common culprits of drug-induced diarrhea, accounting for approximately 25% of cases . The spectrum of antibiotic-associated diarrhea ranges from mild, benign diarrhea to severe conditions like pseudomembranous colitis, often caused by Clostridium difficile infection 23. Common antibiotics implicated include doxycycline, trimethoprim-sulfamethoxazole, fluoroquinolones, and rifaximin .
Laxatives and Osmotic Agents
Laxatives, particularly those containing magnesium or sorbitol, are well-known for causing diarrhea due to their osmotic effects, which draw water into the intestines 23. Lactulose, used in liver disease management, and sorbitol, found in some liquid medications, also induce diarrhea through similar mechanisms .
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs can cause diarrhea by disrupting the gastrointestinal mucosa, leading to inflammation and impaired absorption 29. This category includes common over-the-counter medications like ibuprofen and aspirin.
Antineoplastic Agents
Chemotherapy drugs, such as 5-fluorouracil and irinotecan, frequently cause diarrhea, with incidences reaching up to 80% during treatment . The mechanisms include mucosal damage, inflammation, and altered gut flora .
Other Medications
Other drugs that commonly cause diarrhea include:
- Magnesium-containing antacids: These can cause osmotic diarrhea 23.
- Prostaglandins and cholinergic agents: These increase gastrointestinal motility and secretion .
- α-Glucosidase inhibitors and lipase inhibitors: These interfere with carbohydrate and fat absorption, respectively .
Mechanisms of Drug-Induced Diarrhea
Osmotic Diarrhea
Osmotic diarrhea occurs when non-absorbable substances draw water into the intestines. This is commonly seen with laxatives and certain antacids 23.
Secretory Diarrhea
Some drugs activate adenylate cyclase in intestinal cells, increasing cyclic AMP levels and causing active secretion of electrolytes and water into the gut lumen. Examples include bisacodyl and misoprostol .
Inflammatory Diarrhea
Drugs like NSAIDs can cause inflammation of the gastrointestinal mucosa, leading to diarrhea. This inflammation can result in exudative diarrhea, where the inflamed mucosa secretes fluids and proteins 29.
Altered Gut Motility
Drugs can either increase or decrease gut motility. Increased motility, seen with cholinergic agents, can lead to diarrhea by reducing the time available for water absorption . Conversely, decreased motility can cause bacterial overgrowth and subsequent diarrhea .
Clinical Considerations and Management
Acute vs. Chronic Diarrhea
Drug-induced diarrhea can be acute, appearing within days of starting a medication, or chronic, persisting for weeks or longer 29. Chronic diarrhea may be particularly challenging to diagnose in patients on multiple medications .
Diagnostic Approach
A thorough medical and drug history is crucial for diagnosing drug-induced diarrhea. Identifying the offending drug can prevent unnecessary diagnostic tests and treatments 27.
Treatment Strategies
The primary treatment involves discontinuing the offending drug. In some cases, diarrhea may resolve with continued use or through nonspecific agents like loperamide . For severe cases, fluid and electrolyte replacement, and sometimes specific therapies like antibiotics for C. difficile infection, are necessary 78.
Conclusion
Drug-induced diarrhea is a common and often under-recognized adverse effect of many medications. Understanding the mechanisms and identifying the offending drugs are crucial for effective management and prevention of complications. Clinicians should maintain a high index of suspicion for drug-induced diarrhea, especially in patients on multiple medications.
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