What medications cause diarrhea
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Medications That Cause Diarrhea
Diarrhea is a common adverse effect of many medications, affecting a significant portion of patients. Understanding which medications are most likely to cause diarrhea and the mechanisms behind this side effect can help in managing and preventing it.
Common Medications Causing Diarrhea
Antimicrobials and Antibiotics
Antimicrobials are a leading cause of drug-induced diarrhea, responsible for about 25% of cases. Antibiotics such as doxycycline, trimethoprim-sulfamethoxazole, fluoroquinolones, and rifaximin are frequently implicated. These medications can disrupt the gut microbiota, leading to conditions ranging from mild diarrhea to severe pseudomembranous colitis caused by Clostridium difficile 1278.
Laxatives and Osmotic Agents
Laxatives, including those containing magnesium (e.g., magnesium trisilicate or hydroxide) and osmotic agents like lactulose and sorbitol, are designed to induce bowel movements and can cause diarrhea as a side effect. These agents increase the osmotic load in the intestines, drawing water into the bowel and leading to diarrhea 14.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs, such as ibuprofen and naproxen, can cause gastrointestinal irritation and diarrhea. These drugs can disrupt the mucosal lining of the intestines, leading to inflammation and increased bowel movements 14.
Antineoplastic Agents
Chemotherapy drugs, particularly 5-fluorouracil and irinotecan, are notorious for causing diarrhea. The incidence of diarrhea during chemotherapy can reach up to 80%, with severe cases occurring in about one-third of patients. The mechanisms include mucosal damage, inflammation, and altered absorption of nutrients 1910.
Other Medications
Several other medications are known to cause diarrhea, including:
- Magnesium-containing antacids: These can cause osmotic diarrhea by drawing water into the intestines 14.
- Lactose- or sorbitol-containing products: These can lead to osmotic diarrhea, especially in individuals with lactose intolerance .
- Prostaglandins and cholinergic agents: These can increase intestinal motility and secretion, leading to diarrhea 14.
- α-Glucosidase inhibitors and lipase inhibitors: These drugs, used in diabetes and weight management, respectively, can cause diarrhea by affecting carbohydrate and fat absorption .
Mechanisms of Drug-Induced Diarrhea
Osmotic Diarrhea
Osmotic diarrhea occurs when non-absorbable substances draw water into the intestines. This is common with laxatives, magnesium-containing antacids, and certain sugar alcohols like sorbitol 14.
Secretory Diarrhea
Some drugs increase the secretion of electrolytes and water into the intestines, leading to secretory diarrhea. Examples include certain antibiotics and chemotherapy agents 1410.
Inflammatory Diarrhea
Drugs that cause inflammation of the intestinal mucosa, such as NSAIDs and some antineoplastic agents, can lead to inflammatory diarrhea. This type of diarrhea is often accompanied by blood and mucus in the stool 1410.
Malabsorption
Certain medications can interfere with the absorption of nutrients, leading to malabsorption and diarrhea. This is seen with drugs like neomycin and colchicine, which can damage the intestinal mucosa 14.
Clinical Management
Identifying drug-induced diarrhea involves a thorough medical history, including a review of all medications. Management typically includes discontinuing the offending drug, if possible, and using supportive treatments like loperamide to control symptoms. In severe cases, hospitalization and intravenous fluids may be necessary 134910.
Conclusion
Drug-induced diarrhea is a common and often challenging side effect of many medications. By understanding the medications that cause diarrhea and the mechanisms involved, healthcare providers can better manage and prevent this condition, improving patient outcomes.
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