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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 1 مورد

Antimotility and antisecretory agents used for high-output fistulas in adult patients

Antimotility and antisecretory agents used for high-output fistulas in adult patients
Drug Initial dose Maximum dose Considerations
Loperamide 2 to 4 mg orally four times daily 8 mg/day four times daily
  • Antimotility agent of choice
  • Avoid liquid due to propylene glycol content
  • Use caution with doses >16 mg/day*
Diphenoxylate-atropine 2.5 mg/0.025 mg (1 tablet) orally four times daily 2 tablets four times daily (20 mg diphenoxylate/0.2 mg atropine per day)
  • Avoid liquid formulation due to sorbitol content
Pantoprazole 80 mg IV twice daily or 40 mg orally twice daily 80 mg IV twice daily or 40 mg orally twice daily
  • Discontinue as soon as feasible
  • Oral formulation may not be adequately absorbed
Famotidine 20 mg IV or orally twice daily 40 mg IV or orally twice daily
  • H2RAs are alternatives to high-dose proton pump inhibitors in patients with treatment-refractory hypomagnesemia
Cimetidine 400 mg orally four times daily 600 mg orally four times daily
  • H2RAs are alternatives to high-dose proton pump inhibitors in patients with treatment-refractory hypomagnesemia
Codeine 15 mg orally twice daily 15 mg orally four times daily
  • May be used as an alternative or add-on for patients with an insufficient response to loperamide or diphenoxylate
  • Monitor for CNS and respiratory effects
Octreotide (intermittent) 100 mcg IV or subcutaneously three times daily 150 mcg IV or subcutaneously three times daily
  • Discontinue if output not decreased after 3 days
  • Potentially less nausea with continuous infusion
Octreotide (continuous IV infusion) 12.5 mcg/hour IV continuous infusion 50 mcg/hour IV continuous infusion
  • Discontinue if output not decreased after 3 days
  • Potentially less nausea with continuous infusion
For use with UpToDate content on the management of enterocutaneous and enteroatmospheric fistulas. Some agents (eg, H2RAs) require dose adjustment for kidney impairment. For specifics, refer to the Lexidrug reference within UpToDate.

CNS: central nervous system; H2RA: histamine-2 receptor antagonist; HR: heart rate; IV: intravenous.

* Because supratherapeutic doses of loperamide can prolong QTc interval and cause cardiac arrhythmias, it is advisable to obtain an electrocardiogram when increasing the dose to >16 mg/day.

Original figure modified for this publication. From: Parli SE, Pfeifer C, Oyler DR, et al. Redefining "bowel regimen": Pharmacologic strategies and nutritional considerations in the management of small bowel fistulas. Am J Surg 2018; 216:351. Table used with the permission of Elsevier Inc. All rights reserved.
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