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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Medications and nutrient supplements commonly used in malabsorption and maldigestion

Medications and nutrient supplements commonly used in malabsorption and maldigestion
Medication/supplement Comments
Antidiarrheal agents
Loperamide 2 to 4 mg as needed. Not to exceed 16 mg/day.
  • Preferred initial antidiarrheal.
  • Gradually titrate down to minimum required.
  • Commercial liquids (1 mg/5 mL or 1 mg/7.5 mL) also available.
Diphenoxylate-atropine (2.5/0.025 mg). 1 to 2 tablets after each loose stool. Not to exceed 8 tablets/day.
  • Each tablet contains 2.5 mg diphenoxylate (synthetic opioid).
  • Atropine ingredient is to discourage abuse; causes anticholinergic effects with excess dosing.
  • Commercial liquid (2.5/0.025 mg/5 mL) also available.
Deodorized tincture of opium 1% solution (contains 10 mg morphine per mL) 0.3 to 0.8 mL in water three times daily.
  • Effective alternative in severe diarrhea with insufficient response to loperamide and diphenoxylate.
  • US DEA C-II controlled substance; addictive potential.
  • Avoid abrupt discontinuation, which may produce withdrawal syndrome.
  • Not recommended for use in patients with a history of substance abuse.
Bile acid binding resins for bile acid malabsorption-associated diarrhea [cholorrhea], not fat malabsorption
Cholestyramine 4 g once daily initially; increase gradually (eg, weekly) to 4 g three times daily.
  • May reduce absorption of other drugs and supplements; administer either ≥1 hour before or 4 to 6 hours after other drugs and supplements. Refer to drug interactions database.
  • Available as 4 g packets and 4 g/scoop bulk powder.
Colestipol:
  • Granules: 5 g once or twice daily; increase gradually to 5 g three times daily
  • Tablets: 2 g once or twice daily; increase gradually to 2 g three times daily
  • May reduce absorption of other drugs and supplements; administer either ≥1 hour before or 4 to 6 hours after other drugs and supplements. Refer to drug interactions database.
Pancreatic enzymes for exocrine pancreatic insufficiency
Pancrelipase microencapsulated, delayed-release (eg, Creon). Initially 30,000 USP units lipase (~500 USP units lipase/kg) with meals and half of that amount with snacks; adjust gradually to patient needs*.
  • Use in patients with intact upper GI tract and intact gastric secretions.
Pancrelipase, non-microencapsulated (eg, Viokace). Initially 30,000 USP units lipase (~500 USP units lipase/kg) with meals and half of that amount with snacks; adjust gradually to patient needs*.
  • Inactivated by stomach acid. Use in patients lacking acid-peptic gastric environment or administer with acid-suppressing drug.
Vitamins and minerals (doses for oral acute repletion cited; required maintenance doses are usually lower but vary widely)
Vitamin A 40,000 to 50,000 units (12,000 to 15,000 mcg retinol activity equivalent) twice daily.
  • Periconceptional exposure to a single dose of >25,000 units or >10,000 units/day has been reported to be teratogenic, so take caution in women of child-bearing age.
Vitamin D3 (cholecalciferol) 10,000 to 50,000 units (250 to 1250 mcg)/day individualized according to serum 25(OH)D level.
  • Patients who remain deficient on such doses will need to be treated with hydroxylated vitamin D metabolites (eg, calcitriol) because they are more readily absorbed.
Vitamin K (phytonadione) 2.5 to 12.5 mg/day.
  • Intravenous preparation available.
Folic acid 1 mg/day.  
Vitamin B12 (cyanocobalamin) 1 mg subcutaneously or intramuscular, repeat 3 times in first week. Acute oral repletion not recommended.
  • Formulations are available for intramuscular/deep subcutaneous injection and oral, sublingual, and nasal administration.
  • 1 mg/day orally often sufficient for maintenance of pernicious anemia.
Calcium carbonate 500 mg (200 mg elemental calcium) twice daily.  
Magnesium gluconate 1 to 4 g (54 to 216 mg elemental magnesium) four times daily.
  • Often exacerbates diarrhea, necessitating parenteral replacement.
Ferrous sulfate 325 mg (65 mg elemental iron) three times daily.
  • Available as oral liquids in multiple concentrations.
  • Equivalent dose mixed in 8 to 12 ounces (240 to 360 mL) of orange juice or taken with a 250 mg ascorbic acid tablet enhances bioavailability.
All dosages oral unless indicated otherwise.
USP: United States pharmacopeia.
* In most adult patients, 90,000 USP units of lipase per meal is the amount that will be needed to abolish steatorrhea. Pancreatic enzyme replacement products available in various countries are not equivalent; consult local labeling before prescribing.
¶ Refer to UpToDate clinical topics and Lexicomp drug monographs (included with UpToDate) for details of dosing and treatment of acute deficiency in setting of malabsorption.
Modified from: Heimburger DC, Weinsier RL. Gastrointestinal and liver diseases, In: Handbook of Clinical Nutrition, 3rd ed, Heimburger DC, Weinsier RL (Eds), Mosby, St Louis 1997. p.424 with additional data from Lexicomp Online. Copyright © 1978-2024 Lexicomp, Inc.
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