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At least 19 recordsLinked to original sources
PubMed1979

Dissociation between opiate-like and antidiarrheal activities of antidiarrheal drugs.

Three synthetic antidiarrheals, diphenoxylate, loperamide and SC 27166, and two narcotics, morphine and codeine, were evaluated in rats by the intravenous and oral route for specificity and duration of their antidiarrheal, opiate-like and acute toxic effects. The activity in the castor oil test, the tail withdrawal test and the acute toxicity test was used to determine the relative antidiarrheal specificity and relative safety margins. An analysis of animal and clinical data indicate these tests to be excellent indicators of clinical usefulness and specificity. Intravenously, all five agents induced opiate-like central effects, loperamide and SC 27166 at near toxic doses only. When administered orally loperamide and SC 27166 were devoid of opiate-like central nervous system activity. Analysis of the plasma levels after oral loperamide indicated that this drug does not attain a concentration high enough to induce opiate-like central effects. All agents were effective antidiarrheals by the oral route with loperamide being the most potent (ED50 = 0.15 mg/kg), longest acting (ED50 8 hr = 1.81 mg/kg) and most specific (relative antidiarrheal specificity, 8 hr greater than or equal to 88) and having the greatest relative safety margin (8 hr = 102).

Administration, Oral↗
PubMed1977

Antidiarrheal and central nervous system activities of SC-27166 (2-[3 - 5 - methyl - 1, 3, 4 - oxadiazol - 2 - yl) - 3, 3 - diphenylpropyl] - 2 - azabicyclo [2.2.2]octane), a new antidiarrheal agent, resulting from binding to opiate receptor sites of brain and myenteric plexus.

Pharmacological studies were performed to investigate the interaction of SC-27166 (2-[3-(5-methyl-1,3,4--oxadiazol-2-yl)-3,3-diphenylpropyl]-2-azabicyclo[2.2.2]octane), a new antidiarrheal agent, with opiate receptor sites in vitro and in vivo. Morphine, loperamide and SC-27166 inhibited the binding of [3H]naloxone to homogenates of guinea-pig brain and myenteric plexus and the inhibition was diminished in the presence of 100 mM Na+. Unlike that of morphine and [3H]naloxone itself, the binding of loperamide and SC-27166 was complex and Scatchard plots indicated the presence of low and high affinity sites for both compounds. Morphine, loperamide and SC-27166 inhibited the contractions of electrically driven longitudinal muscle from guinea-pig ileum and naloxone antagonized these effects. In the anesthetized dog, i.v. administration of morphine and SC-27166 enhanced the contractile activity of circular muscle in proximal and distal duodenum and distal ileum but duodenal longitudinal muscle was relaxed; these effects were completely reversed by subsequent administration of naloxone. In the rat, p.o. administration of loperamide and SC-27166 inhibited intestinal propulsion at doses considerably lower than were necessary to produce activity in the hot plate test; this specificity of action was not seen with morphine. In the rat, p.o. administration of loperamide and SC-27166 inhibited diarrhea at doses considerably lower than were necessary to produce withdrawal symptoms. The authors concluded that both loperamide and SC-27166 are specific antidiarrheal agents that produce both their central and antidiarrheal effects by binding to opiate receptor sites.

Animals↗
PubMed1978

In vivo antimotility and antidiarrheal activity of lidamidine hydrochloride (WHR-1142A), a novel antidiarrheal agent. Comparison with diphenoxylate and loperamide.

1-(2,6-Dimethylphenyl)-3-methyl-amidinourea hydrochloride (WHR-1142A, lidamidine hydrochloride) was shown to have potent antimotility, antidiarrheal and intestinal antisecretory activity in mice, rats and dogs. Antimotility activity was demonstrated in charcoal intestinal motility, gastric emptying and gastric and intestinal intraluminal pressure studies. Antidiarrheal activity was evaluated in castor oil-, prostaglandin E2-, carbachol-, and serotonin-induced diarrhea. Intestinal secretion induced by cholera toxin was inhibited by WHR-1142A. In general, WHR-1142A was more potent than diphenoxylate and loperamide although species differences were noted. The ED50 for inhibition of castor oil-induced diarrhea was 1.8 mg/kg p.o. and the duration of action at 16 mg/kg p.o. was at least 6 h. Unlike diphenoxylate, WHR-1142A showed no tolerance.

Amidines↗
PubMed2000

Randomized comparison of prophylactic antidiarrheal treatment versus no prophylactic antidiarrheal treatment in patients receiving CPT-11 (irinotecan) for advanced 5-FU-resistant colorectal cancer: an open-label multicenter phase II study.

Delayed diarrhea is the main toxicity of irinotecan at the currently recommended dose of 350 mg/m2 30-minute intravenous infusion, once every 3 weeks. This phase II, multicenter, open-label, randomized study was primarily designed to evaluate the effect of a 15-day Tiorfan (racecadotril) treatment on the incidence and severity of irinotecan-induced delayed diarrhea. One hundred thirty-six patients with metastatic colorectal cancer who failed to respond to a 5-fluorouracil-based treatment received 714 cycles of irinotecan. The patients were randomly allocated either to group A (68 patients) and received Tiorfan (300 mg/day) from D0 to D15 or to group B (68 patients) with no prophylactic treatment. Delayed diarrhea occurred in 197 of 355 cycles (55%) in Group A and 203 of 344 cycles (59%) in Group B. grade III-IV diarrhea was reported in 17 of 40 compliant patients (42%) in group A and 31 of 68 evaluable patients (45%) in group B. No difference was observed between the two groups for delayed diarrhea characteristics, incidence, or severity. The response rate in 99 evaluable patients was 12.1% (6.4%-20.2%). This study has shown that Tiorfan given prophylactically at 300 mg/day has no effect on delayed diarrhea.

Adult↗
PubMed1990

Over-the-counter antidiarrheal medications used for the self-treatment of acute nonspecific diarrhea.

Because there are approximately 100 over-the-counter (OTC) products available for self-treatment of acute diarrhea, it is difficult for consumers or even pharmacists and physicians to be sure which products are both safe and effective. Until Congress expanded the authority of the Food and Drug Administration in 1962, manufacturers only had to prove that their products were safe. Unfortunately, a majority of OTC products that are now available were on the market before 1962. To eliminate all noneffective products, the Food and Drug Administration established a three-phase OTC drug review process. The ultimate goal of this process is to ensure that all OTC medications are safe and effective and carry full and informative labeling. In 1975, the Advisory Review Panel on OTC Laxative, Antidiarrheal, Emetic, and Antiemetic Drug Products published its recommendations on which OTC antidiarrheal ingredients were both safe and effective [Antidiarrheal drug products for over-the-counter human use: proposed monograph. Federal Register 1975; 40: 12902-12944]. After consideration of these recommendations, public comment, and presented new evidence, the Food and Drug Administration published its preliminary safe and effective ingredient listing [Antidiarrheal drug products for over-the-counter human use: tentative final monograph. Federal Register 1986; 51 (83): 16138-16149]. At this time, only three ingredients fulfill both requirements: attapulgite, polycarbophil, and loperamide. The Food and Drug Administration's final decision (to be reported in a monograph) is still forthcoming. Upon publication of this monograph, only antidiarrheal products that contain ingredients in this listing will be allowed to be marketed.

Acute Disease↗
PubMed1985

Studies of the antidiarrheal action of clonidine. Effects on motility and intestinal absorption.

Clonidine, an alpha 2-adrenergic agonist, has been reported to stimulate the rate of electrolyte absorption in vitro, to alter intestinal motility in vivo, and to have antidiarrheal effects in animals. Experiments were performed in 8 healthy volunteers in order to evaluate the antidiarrheal effect of clonidine in humans. When diarrhea was induced by intragastric infusion of 2700 ml of balanced electrolyte solution over 90 min, oral administration of 0.3 mg of clonidine reduced the volume of rectal effluent by 48% (from 1233 +/- 62 to 640 +/- 77 ml, p less than 0.001), a clear-cut antidiarrheal effect. Clonidine increased total gut volume significantly (from 987 +/- 91 to 1830 +/- 142 ml, p less than 0.001), suggesting that clonidine exerted its antidiarrheal effect by altering gut motility, i.e., increasing the capacity of the gut and slowing the transit of fluid through the intestine. In other experiments, the net absorption rate of the whole gut during steady state total gut perfusion was measured. The rate of absorption of fluid was transiently stimulated by clonidine by 15% (from 696 +/- 77 to 799 +/- 55 ml/h, p less than 0.02), indicating an additional effect on mucosal cell function. These studies indicate that in this experimental diarrhea model, clonidine has antidiarrheal properties that are due largely to effects on motility of the gut but that clonidine also modestly stimulates the net rate of absorption by intestinal mucosa.

Adult↗
PubMedDate not supplied

Is in vivo dissociation between the antipropulsive and antidiarrheal properties of opioids in rats related to gut selectivity?

The antipropulsive activity of a series of opioids in the charcoal test was compared with their antidiarrheal activity in the castor oil test and their analgesic activity in the tail withdrawal test. The obtained antipropulsive/antidiarrheal potency ratios varied from 0.71 to greater than 552 [pethidine (oral ED50's in mg/kg: 21.5/30.2), fentanyl (0.77/0.49), dextromoramide (5.39/2.90), methadone (14.2/6.38), codeine (98.4/10.8), morphine (56.6/5.21), diphenoxylate (8.15/0.54), nufenoxole (74.7/1.72), difenoxin (7.10/0.16), loperamide oxide (greater than 160/0.34) and loperamide (greater than 160/0.29)]. The above ratios correlated with the gut selectivity of the compounds as defined by their analgesic/antidiarrheal potency ratios (r = 0.92, P less than 0.001). Furthermore, inhibition of propulsion was found to correlate with central analgesic activity (r = 0.93, P less than 0.001) but not with protection from diarrhea (r = 0.023, P greater than 0.05). Indeed, gut-selective opioids such as loperamide and loperamide oxide failed to affect propulsion up to doses more than 450 times their antidiarrheal doses. In contrast, alpha 2-adrenoceptor agonists delayed propulsion at doses comparable to their antidiarrheal doses [clonidine (0.085 vs 0.021), lidamidine (2.35 vs 1.66)] and anticholinergics inhibited propulsion even at doses many times below their antidiarrheal doses [atropine (0.26 vs 9.30), dexetimide (0.13 vs 5.03) and isopropamide (0.78 vs 74.6)]. The present results indicate that the in vivo inhibition of gastrointestinal propulsion by opioids in rats is mediated by a central action. Effects on intestinal fluid transport or, alternatively, on motility events distal to the ileocecal junction rather than effects on propulsion through the small intestine, seem to be the primary mechanism of antidiarrheal action of gut-selective opioids such as loperamide and loperamide oxide.

Adrenergic alpha-Agonists↗
PubMed1998

Antidiarrheal agents for the management of treatment-related diarrhea in cancer patients.

The efficacy and use of antidiarrheal agents in patients who diarrhea associated with cancer treatments are reviewed. Diarrhea is common in cancer patients and may interfere with cancer treatment. Diarrhea may be induced by chemotherapy, radiation therapy, surgery, graft-versus-hot disease (GVHD) or infection after bone marrow transplantation, and other causes. The general goal of antidiarrheal therapy is to reduce fluid loss in the stool by inhibiting intestinal secretion, promoting absorption, and decreasing intestinal motility. Antidiarrheal agents may be classified as intestinal transit inhibitors, intraluminal agents, proabsorptive agents, and antisecretory drugs. Opiate agonists are the most commonly used intestinal transit inhibitors; they can be effective in treating cancer treatment-related diarrheas but must be used cautiously. Intraluminal agents include clays, activated charcoal, and cholestyramine; these adsorbents and other binding resins can interfere with the absorption of orally administered antidiarrheals and other drugs and are unlikely candidates for use in most cases of diarrhea in cancer patients. Clonidine, a proabsorptive agent, should be used only in patients with secretory diarrhea refractory to opiate agonist treatment. Octreotide is an antisecretory drug that has shown considerable efficacy in clinical trails as a treatment for diarrhea caused by chemotherapy of GVHD; its use for radiation therapy-induced diarrhea, although not studied clinically, is nevertheless an option. In general, opiate agonists and octreotide appears to offer the most efficacy and flexibility. Opiate agonists and octreotide are effective agents for cancer treatment-related diarrhea.

Antidiarrheals↗
PubMed2002

Pharmacological studies on Myristica fragrans--antidiarrheal, hypnotic, analgesic and hemodynamic (blood pressure) parameters.

Recurrent diarrhea is prevalent in developing countries, particularly in tropical regions. A natural based antidiarrheal home remedy can serve as an ideal health tool to limit diarrhea-related morbidity and mortality. In the traditional Indian medical science of Ayurveda, nutmeg is one such plant said to possess antidiarrheal activity. A study was therefore planned to assess the various pharmacological effects (antidiarrheal, sedative, analgesic and blood pressure) of nutmeg. Both Nutmeg crude suspension (NMC) and petroleum ether (PE), but not aqueous extract (Aq), decreased the mean number of loose stools or increased the latency period. NMC increased intestinal tone while PE had no such effect. PE had no effect on guinea pig ileum, but inhibited the contraction produced by acetylcholine, histamine and prostaglandin. NMC but not PE extract showed a significant but weak analgesic effect. While PE effectively potentiated both phenobarbitone and pentobarbitone-induced sleeping time, NMC was considerably less effective. NMC administered intraduodenally did not produce much effect on blood pressure (BP), but potentiated the action of exogenously administered adrenaline and nor-adrenaline. On the other hand, PE in higher, but not lower, doses caused a precipitous fall in BP not blocked by atropine. Thus, overall extracts of nutmeg showed a good antidiarrheal effect, with a significant sedative property. The extracts possessed only a weak analgesic effect, with no harmful effects on blood pressure and ECG.

Administration, Oral↗
PubMed1977

The pharmacology of SC-27166: a novel antidiarrheal agent.

SC-27166 is the result of continuing efforts to discover selective and orally active antidiarrheal agents. SC-27166, which is chemically unrelated to opiates or neuroleptics, possesses potent constipating and antidiarrheal activity in several animal models. Tolerance to the constipating actions of SC-27166 did not develop in mice. On the other hand, gut tolerance rapidly developed to morphine sulfate and loperamide. The basic mechanism of the antidiarrheal action of SC-27166 is a consequence of increased intestinal circular muscle contractile activity. Supportive pharmacological studies indicated that SC-27166 has equivocal analgesia in mice which is manifested at near toxic dose levels. SC-27166 was also evaluated for potential dependence liability in morphine abstinence-induced jumping in mice. The abstinence-induced jumping was suppressed to a far lesser extent by SC-27166 than by either loperamide or diphenoxylate at equal doses. SC-27166 was also devoid of anticbholinergic activity. When compared with the reference standards morphine and diphenoxylate, these pharmacological studies indicated that SC-27166 has a high degree of separation of undesirable central nervous system actions from its antidiarrheal properties and may have important therapeutic potential.

Analgesics↗
PubMed1991

Spinally mediated opioid antidiarrheal effects.

To assess the role of opioid receptors in the spinal cord in regulation of functions of the intestinal mucosa in a secretory model, we evaluated the ability of i.t. administered mu (PL017), delta (DPDPE) and kappa (U50,488H) selective opioid agonists to inhibit diarrhea produced in mice by an injection of prostaglandin E2 (PGE2) (200 micrograms/mouse, i.p.). I.t. PL017 and DPDPE inhibited diarrhea in a dose-related fashion. U50,488H had only minimal antidiarrheal effects. The i.t. doses of PL017 and DPDPE required to inhibit diarrhea were higher than the doses required to produce antinociception and inhibit gastrointestinal transit. Spinally administered PL017 and DPDPE were considerably less potent in the diarrhea model than after i.c.v. administration but far more effective than after peripheral (s.c.) dosing. The antidiarrheal effects of spinally administered opioids were antagonized by concurrently administered naloxone. These data indicate that opioid chemosensitive sites in the spinal cord can modulate diarrhea produced by PGE2, and that the receptor specific opioids, PL017 and DPDPE, and to a lesser extent U50,488H, all possess antidiarrheal activity when administered i.t.

3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cycloh↗
PubMed2001

Polyamine analogue antidiarrheals: a structure-activity study.

The syntheses of a group of spermine polyamine analogues and their evaluation as antidiarrheals are described. Each compound was assessed in a rodent castor oil-induced diarrhea model for its ability to reduce stool output and weight loss in a dose-dependent manner. The spermine pharmacophore is shown to be an excellent platform from which to construct antidiarrheals. The activity of the compounds is very dependent on both the nature of the terminal alkyl groups and the geometry of the methylene spacers separating the nitrogens. The toxicity profile is also quite dependent on these same structural features. On the basis of subcutaneous dose-response data and toxicity profiles, two compounds, N(1),N(12)-diisopropylspermine and N(1),N(12)-diethylspermine, were taken forward into more complete evaluation. These measurements included formal acute and chronic toxicity trials, drug and metabolic tissue distribution studies, and assessment of the impact of these analogues on tissue polyamine pools. Finally, the remarkable activity of N,N'-bis[3-(ethylamino)propyl]-trans-1,4-cyclohexanediamine underscores the need to further explore this framework as a pharmacophore for the construction of other antidiarrheal agents.

Administration, Oral↗
PubMed1988

Pharmacological aspects of therapy in inflammatory bowel diseases: antidiarrheal agents.

We review the use of antidiarrheal medications in inflammatory bowel disease, commenting on potential underlying immunologic mechanisms as a background for discussion of the clinical usage of antidiarrheal medications in this disease spectrum. We comment on new directions for the development of more effective therapeutic approaches and discuss the mechanism of action of antidiarrheal drugs, with emphasis on synthetic opiates.

Antidiarrheals↗
PubMed2001

Antidiarrheal activity of wood creosote: inhibition of muscle contraction and enterotoxin-induced fluid secretion in rabbit small intestine.

Wood creosote has long been used as an antidiarrheal agent, but its mechanism of action is not well understood. To elucidate the mechanism of its antidiarrheal activity, we have addressed questions whether it inhibits fluid secretion induced by Escherichia coli heat-stable enterotoxin (STa) in rabbit jejunum in vivo, and whether it inhibits muscle contraction of isolated rabbit ileum ex vivo. Wood creosote (10-100 mg/l) instilled in a ligated loop of jejunum inhibited STa-induced fluid secretion (p < 0.05). It also inhibited the spontaneous phasic, acetylcholine-induced tonic and Ba2+-induced tonic contractions of longitudinal and circular muscles of ileum dose-dependently with IC(50) values of 130-530 mg/l. These data provide further evidence that the antidiarrheal activity of wood creosote is attributable to its antisecretory and antimotility effects.

Acetylcholine↗