Antipropulsive

Antipropulsive drugs, as the name suggests, act against the propulsive activity of the intestines, thus slowing down the transit of intestinal contents. They are primarily used to manage and treat diarrhea by reducing the frequency and urgency of bowel movements. It's worth noting that while antipropulsives can provide symptomatic relief, they don't target the root cause of diarrhea, such as infections or malabsorption syndromes.

Mechanism of Action

Antipropulsives work mainly by slowing down gut motility. This reduced motility allows for increased absorption of water and salts from the fecal matter, thereby solidifying the stool. However, their mode of action does not necessarily resolve the underlying pathology causing the diarrhea.

• Diphenoxylate: This drug acts on the central nervous system to inhibit the peristaltic reflex, effectively slowing down bowel movements.
• Loperamide: It acts directly on the muscles of the intestine, increasing the tone of the internal anal sphincter and thus reducing the speed of intestinal contractions.

Indications

Antipropulsives are indicated for:

• Acute and chronic diarrhea of various etiologies.
• Reducing the number of bowel movements in patients with ileostomies.
• Occasionally in cases of IBS with predominant diarrhea.

Contraindications

It's essential to be aware of situations where antipropulsives should not be used, including:

• Infectious diarrhea, where decreased motility could prolong infection.
• Diarrhea caused by certain bacteria like Clostridium difficile, as slowing the transit could lead to complications like toxic megacolon.
• In children below a specific age (as per drug-specific recommendations).
• Patients with a known history of hypersensitivity to the drug.

Side Effects

Like all drugs, antipropulsives come with potential side effects. Common ones include:

• Constipation
• Abdominal cramps
• Dizziness
• Dry mouth
• Fatigue

Conclusion

While antipropulsives like diphenoxylate and loperamide can offer relief from diarrhea by reducing intestinal motility, it's crucial to address and treat the underlying cause of diarrhea. Over-reliance without addressing the root cause can lead to complications. As with all medications, they should be used judiciously and under appropriate medical guidance.

See Also

• Gastrointestinal tract
• Diarrhea
• Antidiarrheal agents
• propulsive

References

• [1] Hardman, JG., Limbird, LE. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 10th ed. New York: McGraw-Hill; 2001.
• [2] Johnson, DA., Barkun, AN., Cohen, LB., et al. Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer. Am J Gastroenterol. 2014;109(10):1528-1545.