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Antidiarrheal therapy

Prospects for new agents

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Abstract

Successful treatment of severe diarrhea has traditionally relied upon opiates or opiate derivatives. Recent advances in our understanding of intestinal fluid and electrolyte absorption have provided the opportunity to develop therapeutic agents specific for various points in the secretory and absorptive process. Present and proposed antidiarrheal agents, in addition to antimotility activity, will be capable of stimulating intestinal fluid absorption, inhibiting intestinal fluid secretion, or both. The mechanism(s) of action and clinical implications for proposed antidiarrheal agents are reviewed.

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References

  1. Holmgren J, Svennerholm AM: Pathogenic mechanisms and new perspectives in the treatment and prevention of enteric infection. Scand J Gastroenterol (Suppl) 77:47–54, 1982

    Google Scholar 

  2. Lemp GF, Woodward WE, Pickering LK, Sullivan PS, Dupont HL: The relationship of staff to the incidence of diarrhea in day-care centers. Am J Epidemiol 120:750–758, 1984

    Google Scholar 

  3. Awouters F, Niemegeers CJ, Janssen PA: Pharmacology of antidiarrheal drugs. Annu Rev Pharmacol Toxicol 23:279–301, 1983

    Google Scholar 

  4. Chang EB, Field M: Intestinal electrolyte transport and diarrheal disease.In Gastroenterology Annual 1. F Kern, AJ Blum (eds). New York, Elsevier Science Publishers, 1983, pp 148–180

    Google Scholar 

  5. Powell DW, Field M: Pharmacologic approaches to secretory diarrhea.In Secretory Diarrhea. M Field, JS Fordtran, SG Schultz (eds). Baltimore, Williams and Wilkins, 1980, pp 187–210

    Google Scholar 

  6. Field M, McColl I: Ion transport in rabbit ileal mucosa. III. Effects of catecholamines. Am J Physiol 225:852–857, 1973

    Google Scholar 

  7. Chang EB, Field M, Miller RJ: Alpha-2 adrenergic receptor regulation of ion transport in rabbit ileum. Am J Physiol 242:G237-G242, 1982

    Google Scholar 

  8. Turner JT, Ray-Prenger C, Bylund DB: Alpha-2 adrenergic receptors in the human cell line, HT29. Characterization with the full agonist radioligand [3H]UK-14,304 and inhibition of adenylate cyclase. Mol Pharmacol 28:422–430, 1985

    Google Scholar 

  9. Ruwart MJ, Klepper MS, Rush BD: Clonidine delays small intestinal transit in the rat. J Pharmacol Exp Ther 212:487–490, 1980

    Google Scholar 

  10. Douglas GH, Diamond J, Studt WL, Mir GN, Alioto RL, Auyang K, Burns BJ, Cias J, Darkes PR, Dodson SA, O'Connor S, Santora NJ, Tsuei CT, Zalipsky JJ, Zimmerman HK: Antimotility and antisecretory activity of some aryl substituted amidinoureas. Arzneim-Forsch 28:1435–1441, 1978

    Google Scholar 

  11. Durbin T, Rosenthal L, McArthur K, Anderson D, Dharmsathaphorn K: Clonidine and lidamidine stimulate sodium and chloride absorption in the rabbit intestine. Gastroenterology 82:1352–1358, 1982

    Google Scholar 

  12. Lal H, Shearman GT, Ursillo RC: Nonnarcotic antidiarrheal action of clonidine and lofexidine in the rat. J Clin Pharmacol 21:16–19, 1981

    Google Scholar 

  13. Nakaki T, Chang PC, Tokunaga Y, Kato R: Alpha-2 adrenoreceptors modulating diarrhea in morphine-dependent rats. J Pharm Pharmacol 33:397–399, 1981

    Google Scholar 

  14. Spraggs CF, Bunce KT: Alpha-2 adrenoreceptors and the delay of castor oil-induced diarrhea by clonidine in rats. J Pharm Pharmacol 35:321–322, 1983

    Google Scholar 

  15. McArthur KE, Anderson DS, Durbin TE, Orloff MJ, Dharmsathaphorn K: Clonidine and lidamidine inhibit watery diarrhea in a patient with lung cancer. Ann Intern Med 96:323–325, 1982

    Google Scholar 

  16. Gold MS, Redmond ED Jr, Kleber HD: Clonidine blocks acute opiate-withdrawal symptoms. Lancet 2:599–602, 1978

    Google Scholar 

  17. Fedorak RN, Field M, Chang EB: Treatment of diabetic diarrhea with clonidine. Ann Intern Med 102:197–199, 1985

    Google Scholar 

  18. Chang EB, Bergenstal RM, Field M: Diarrhea in streptozocin-treated rats. Loss of adrenergic regulation of intestinal fluid and electrolyte transport. J Clin Invest 75:1666–1670, 1985

    Google Scholar 

  19. Chang EB, Fedorak RN, Field M: Experimental diabetic diarrhea in rats. Intestinal mucosal denervation hypersensitivity and treatment with clonidine. Gastroenterology 91: 564–569, 1986

    Google Scholar 

  20. Leibach JR, Sminsky PG, Justus PG: Lidamidine HCl: A new drug for the treatment of diarrheal disorders. Gastroenterology 81:1207, 1981

    Google Scholar 

  21. Riley RL, Mir GN, Rowles GS, Sperow JW, Alioto RL, Yelnosky J: Effects of lidamidine hydrochloride (WHR 1142A), a novel antidiarrheal agent on the cardiovascular and central nervous systems. Arzneim-Forch 31:1461–1466, 1978

    Google Scholar 

  22. Dhar AK, Eash JR, Mir GN: Antisecretory effects of lidamidine hydrochloride. Fed Proc 42:1367, 1983

    Google Scholar 

  23. Goff JS: Diabetic diarrhea and lidamidine. Ann Intern Med 101:874–875, 1984

    Google Scholar 

  24. Polak JM, Pearse AG, Grimelius L, Bloom SR: Growth-hormone release-inhibiting hormone in gastrointestinal and pancreatic D cells. Lancet 1:1220–1222, 1975

    Google Scholar 

  25. Aliments J, Sundler F, Hakanson R: Distribution, ontogeny and ultrastructure of somatostatin immunoreactive cells in pancreas and gut. Cell Tissue Res 185:465–479, 1977

    Google Scholar 

  26. Guandalini S, Kachur JF, Smith PL, Field M:In vitro effects of somatostatin on ion transport in rabbit intestine. Am J Physiol 238:G67-G74, 1980

    Google Scholar 

  27. Dharmsathaphorn K, Binder HJ, Dobbins JW: Somatostatin stimulates sodium and chloride absorption in the rabbit ileum. Gastroenterology 78:1559–1565, 1980

    Google Scholar 

  28. Freedman J, Rasmussen H, Dobbins JW: Somatostatin stimulates coupled sodium chloride influx across brush border of rabbit ileum. Biochem Biophys Res 97:243–247, 1980

    Google Scholar 

  29. Dharmsathaphron K, Sherwin RS, Dobbins JW: Somatostatin inhibits fluid secretion in the rat jejunum. Gastroenterology 78:1554–1558, 1980

    Google Scholar 

  30. Corter RF, Bitar KN, Zfass AM, Mackhlouf GM: Inhibition of VIP-stimulated intestinal secretion and cyclic AMP production by somatostatin in the rat. Gastroenterology 78:726–730, 1978

    Google Scholar 

  31. Teitelbaum N, O'Dorisio TM, Perkins WE, Giginella TS: Somatostatin modulation of peptide-induced acetylcholine release in guinea pig ileum. Am J Physiol 246:G509-G514, 1984

    Google Scholar 

  32. Binder HJ, Reinprocht J, Dharmasathaphorn K, Dobbins IW: Intestinal peptide receptors. Regul Peptides (Suppl) 1:510, 1980

    Google Scholar 

  33. Dharmsathaphorn K, McRoberts JA, Mondel KG, Tisdale LD, Masui H: A human colonic tumor cell line that maintains vectoral electrolyte transport. Am J Physiol 246:G204-G208, 1984

    Google Scholar 

  34. Krejs GJ: Effect of somatostatin infusion on VIP-induced transport changes in the human jejunum. Peptides 5:271–276, 1984

    Google Scholar 

  35. Ruskone A, Rene E, Chayvialle JA, Bonin N, Pignal F, Kremer M, Bonfils S, Ramband JC: Effect of somatostatin on diarrhea and on small intestinal water and electrolyte transport in a patient with pancreatic cholera. Dig Dis Sci 27:459–466, 1982

    Google Scholar 

  36. Tidemann K, Prichard J, Long R, Bloom SR: Intractable diarrhea in a patient with VIP-secreting neuroblastoma. Eur J Pediatr 137:217–219, 1981

    Google Scholar 

  37. Krejs GJ, Orci L, Conlon JM, Ravazzola M, Davis GR, Raskin P, Collins SM, McCarthy DM, Baetens D, Rubinstein A, Aldor TA, Unger RH: Somatostatinoma syndrome: Biochemical, morphologic and clinical features. N Engl J Med 301:285–294, 1979

    Google Scholar 

  38. Davis GR, Camp RG, Raskin P, Krejs GJ: Effect of somatostatin infusion on jejunal water and electrolyte transport in a patient with secretory diarrhea due to malignant carcinoid syndrome. Gastroenterology 78:346–349, 1980

    Google Scholar 

  39. Dharmsathaphorn K, Sherwin RS, Cataland S, Jaffe B, Dobbins J: Somatostatin inhibits diarrhea in the carcinoid syndrome. Ann Intern Med 92:68–69, 1980

    Google Scholar 

  40. Roberts JL, Hubbard WC, Bloomgarden ZT, Bertagna XY, McKenna TJ, Oates JA: Prostaglandins: Role in the hormonal manifestations of medullary carcinoma of the thyroid and inhibition by somatostatin. Trans Assoc Am Physicians 92:286–291, 1979

    Google Scholar 

  41. Molla MA, Gyr K, Bardhan PK, Molla A: Effect of intravenous somatostatin on stool output in diarrhea due toVibrio cholera. Gastroenterology 87:845–847, 1984

    Google Scholar 

  42. Dharmsathaphorn K, Gorelick FS, Sherwin RS, Cataland S, Dobbins JW: Somatostatin decreases diarrhea in patients with short-bowel syndrome. J Clin Gastroenterol 4:521–524, 1982

    Google Scholar 

  43. Bauer W, Briner U, Doepfnor W, Haller R, Huguenin R, Marbach P, Petcher TJ, Pless J: SMS 201-995: A very potent and selective octopeptide analog of somatostatin with prolonged action. Life Sci 31:1133–1140, 1982

    Google Scholar 

  44. Lamberts SW, Utterlinden P, Zuiderwijk J, Verleum T, Neufeld M, Del Pozo E: The effects of a long-acting somatostatin analogue on growth hormone secretion in rat and man.In 7th International Congress of Endocrinology. F Labrie (ed). Amsterdam, Excerpta Medica. 1984, pp 847

    Google Scholar 

  45. Roberts WG, Fedorak RN, Chang EB:In vitro effects of 201-995 on intestinal ion transport: Comparison of antisecretory effects with SRIF-14 and alpha 2-agonists. Gastroenterology 90:1606, 1986

    Google Scholar 

  46. Williams NS, Cooper JC, Axon ATR, King RF, Barker M: Use of a long acting somatostatin analog in controlling life-threatening ileostomy diarrhea. Br Med J 289:1027–1028, 1984

    Google Scholar 

  47. Mulvhill S, Passaro E, Debas H, Yamada T: Severe diarrhea after colonic pseudoobstruction: Treatment with somatostatin. N Engl J Med 310:467–468, 1984

    Google Scholar 

  48. Rene E, Bonfils S: Control of severe diarrhea with somatostatin. N Engl J Med 311:598, 1984

    Google Scholar 

  49. Maton PN, O'Dorisio TM, Brent A, Howe BA, McArthur KE, Howard JM, Cherner JA, Malarkey TB, Collen MJ, Gardner JD, Jensen RT: Effect of a long-acting somatostatin analog (201-995) in a patient with pancreatic cholera. N Engl J Med 312:17–21, 1985

    Google Scholar 

  50. Santangelo WC, O'Dorisio TM, Kim JG, Severino G, Kregs GJ: Pancreatic cholera syndrome: Effect of a synthetic somatostatin analog on intestinal water and ion transport. Ann Intern Med 103:363–367, 1985

    Google Scholar 

  51. Rosenthal LE, Yamashiro DJ, River J, Vale W, Brown M, Dharmsathaphorn K: Structure-activity relationships of somatostatin analogues in the rabbit ileum and the rat colon. J Clin Invest 71:840–849, 1983

    Google Scholar 

  52. Bukhave K, Rask-Madsen J: Saturation kinetics applied to in vitro effects of low PGE2 on PGF concentrations on ion transport across human jejunum. Gastroenterology 78:32–42, 1980

    Google Scholar 

  53. Wald A, Gotterer GS, Rajendra GR, Turgman NA, Hendrix TR: Effect of indomethacin on cholera induced fluid movement. Gastroenterology 72:106–110, 1977

    Google Scholar 

  54. Farris RK, Tapper ET, Powell DW, Morris SM: Effect of aspirin on normal and cholera toxin-stimulated intestinal electrolyte transport. J Clin Invest 57:916–924, 1976

    Google Scholar 

  55. Jacoby HI, Marshall CH: Antagonism of cholera toxin by antiinflammatory agents in the rat. Nature 235:163–164, 1972

    Google Scholar 

  56. Smith PL, Blumberg JB, Stoff JS, Field M: Antisecretory effects of indomethacin on rabbit ileal mucosain vitro. Gastroenterology 80:356–365, 1981

    Google Scholar 

  57. Steven K, Lange P, Bukhave K, Rask-Maden J: PGE2-mediated secretory diarrhea in villus adenoma of rectum: Effect of treatment with indomethacin. Gastroenterology 80:1562–1566, 1981

    Google Scholar 

  58. Jaffe BM, Kopen DF, Deschryver-Kecskemeti K, Gingerich RL, Greider M: Indomethacin-responsive pancreatic cholera. N Engl J Med 297:817–820, 1977

    Google Scholar 

  59. Ligumsky M, Karmeli F, Sharon P, Zor U, Cohen F, Rachmilewitz D: Enhanced thromboxane A2 and prostacycline production by cultured rectal mucosa in ulcerative colitis and its inhibition by steroids and sulfasalazine. Gastroenterology 81:444, 1981

    Google Scholar 

  60. Zifrani A, Treves AJ, Sachar DB, Rachmilewitz D: Prostanoid synthesis by cultured intestinal epithelial and mononuclear cells in inflammatory bowel disease. Gut 24:659, 1983

    Google Scholar 

  61. Campieri M, Lanfranchi GA, Bozzaehi G, Brignola C, Corazza G, Cortini C, Labo G: Salicylate other than 5-ASA ineffective in ulcerative colitis. Lancet 2:993, 1978

    Google Scholar 

  62. Rampton DS, Sladen GE: Prostaglandin synthesis inhibitors in ulcerative colitis: Flurbiprofen compared to conventional treatment. Prostaglandins 21:457, 1981

    Google Scholar 

  63. Azad-Khan AK, Piris J, Truelove SC: An experiment to determine the active therapeutic moiety of sulfasalazine. Lancet 2:892–895, 1977

    Google Scholar 

  64. Bukhave K, Rask-Madsen J: An approach to evaluation of local intestinal PG production and clinical assessment of its inhibition by indomethacin in chronic diarrhea. Adv Prostaglandins Thrombox Res 8:1627–1631, 1980

    Google Scholar 

  65. Chang EB, Brown DR, Wang NS, Field M: Loperamide selectively inhibits peptide-induced Cl secretion and calcium entry in gut. Gastroenterology 86:1044, 1984

    Google Scholar 

  66. Chang EB, Wang NS, Musch MW: Cellular mechanisms for Ca-activation in isolated enterocytes. Gastroenterology 90(2):1370, 1986

    Google Scholar 

  67. Donowitz M, Levin S, Powers G, Elta G, Cohen P, Cheng H: Calcium-channel blockers stimulate ileal and colonic water absorption. Gastroenterology 89:856–866, 1985

    Google Scholar 

  68. Zinner MJ, Sherlock D, Ferrara A, McFadden D, Wait RB, Jaffe BM: Verapamil inhibition of the intestinal effects of substance P. Surgery 98:230–235, 1985

    Google Scholar 

  69. Thomas DD, Kroop FC: The effect of calcium and prostaglandin inhibitors on the intestinal fluid response to heat-stable enterotoxin ofEscherichia coli. J Infect Dis 145:141, 1982

    Google Scholar 

  70. Narducci F, Bassotti G, Gaburri M, Farroni F, Morelli A: Nifedipine reduces the colonic motor response to eating in patients with irritable colon syndrome. Am J Gastroenterol 80:317–319, 1985

    Google Scholar 

  71. Reynolds IJ, Gould RJ, Snyder SH: Loperamide: Blockade of calcium channels as a mechanism for antidiarrheal effects. J Pharmacol Exp Ther 231:628–632, 1984

    Google Scholar 

  72. Strool R, Ruppin H, Danschke W: Calmodulin mediates the action of loperamide on chloride transport in BBV of human ileum. Gastroenterology 88:1601, 1984

    Google Scholar 

  73. Smith PL, Field M:In vitro antisecretory effects of trifluroperazine and other neuroleptics in rabbit and small intestine. Gastroenterology 78:1545–1553, 1980

    Google Scholar 

  74. Holmgren J, Lange S, Lonnroth I: Reversal of cyclic AMP-mediated intestinal secretion in mice by chlorpromazine. Gastroenterology 75:1103–1108, 1978

    Google Scholar 

  75. Donowitz M, Wicks J, Madara JL, Sharp GW: Studies on role of calmodulin in calcium regulation of rabbit ileal Na and Cl transport. Am J Physiol 248:G726-G740, 1985

    Google Scholar 

  76. Rabbani GH, Holmgren J, Greenough WB, Lonnroth I: Chlorpromazine reduces fluid loss in cholera. Lancet 2:410–412, 1979

    Google Scholar 

  77. Islam MR, Sack DA, Holmgren J, Bardhan PK, Rabbani GH: Use of chlorpromazine in the treatment of cholera and other acute watery diarrheal states. Gastroenterology 82:1335–1340, 1982

    Google Scholar 

  78. Donowitz M, Elta G, Bloom RS: Trifluoperazine reversal of secretory diarrhea in pancreatic cholera. Ann Intern Med 93:284–285, 1980

    Google Scholar 

  79. Gaginella TS, Wu ZC: [d-Ala2,d-Met5 NH2]-enkephalin inhibits acetylcholine release from the submucosal plexus of rat colon. J Pharm Pharmacol 35:823–825, 1983

    Google Scholar 

  80. Brown DR, Miller RJ: Adrenergic mediation of the intestinal antisecretory action of opiates administered into the central nervous system. J Pharmacol Exp Ther 231:114–119, 1984

    Google Scholar 

  81. Kachur JF, Miller RJ, Field M: Control of guinea pig intestinal electrolyte secretion by a delta-opiate receptor. Proc Natl Acad Sci USA 77:2753–2756, 1980

    Google Scholar 

  82. Morgan DR, Sellin J, Gutierrez L, Dupont HL, Wood LU: Evaluation of BW942C, a novel antidiarrheal agent. Infect Immun 48:754–758, 1985

    Google Scholar 

  83. Ericsson CD, Johnson PC, Dupont HL: Role of BW942C in the treatment of acute diarrhea of US adults in Guadalajara Mexico. Abstracts of the 24th International Conference on Antimicrobial Agents and Chemotherapy. 10:822, 1984

  84. Rask-Madsen J, Baastrup PC, Schwartz M: Lithium-induced hyperpolarization of the human rectumin vivo. Br Med J 2:496–498, 1972

    Google Scholar 

  85. Feldman GM, Mann JJ, Charney AN: Effect of lithium ingestion on water and electrolyte transport in rat intestine. Gastroenterology 1:892–897, 1981

    Google Scholar 

  86. Pandol SJ, Korman LY, McCarthy DM, Gardner JD: Beneficial effect of oral lithium carbonate in the treatment of pancreatic cholera syndrome. N Engl J Med 302:1403–1404, 1980

    Google Scholar 

  87. Owyang C: Treatment of chronic secretory diarrhea of unknown origin by lithium carbonate. Gastroenterology 87:714–718, 1984

    Google Scholar 

  88. Dutta NK, Marker PH, Rao NR: Berberine in toxin induced experimental cholera. Br J Pharmacol 44:153–159, 1972

    Google Scholar 

  89. Tai JH, Feser JF, Marnane WG: Reversal of the choleragen-induced intestinal ion secretion in the rat by inhibition of adenylate cyclase activity of berberine. Fed Proc 39:379, 1980

    Google Scholar 

  90. Desai AB, Shah KM, Shah DM: Berberine treatment of diarrhea. Indian Pediatr 8:462–465, 1971

    Google Scholar 

  91. Turjman N, Gotterer GS, Hendrix TR: Prevention and reversal of cholera enterotoxin effects in rabbit jejunum by nicotinic acid. J Clin Invest 61:1155, 1978

    Google Scholar 

  92. Forsyth GW, Kapitany RA, Hamilton DL: Organic acid proton donors decrease intestinal secretion caused by enterotoxins. Am J Physiol 241:G227, 1981

    Google Scholar 

  93. Rabbani GH, Bardham PK, Buther T, Islam A: Reduction of fluid loss in cholera by nicotinic acid. Lancet 1:1439–1441, 1983

    Google Scholar 

  94. Welsh MJ: Anthracene-9-carboxylic acid inhibits an apical membrane chloride conductance in canine tracheal epithelium. J Membr Biol 78:61–71, 1984

    Google Scholar 

  95. Horvath P, Ferriola P, Weiser M, Duffy M: Localization of chloride secretion in rabbit colon by inhibition with anthracene-9-carboxylic acid. Fed Proc 44:1744, 1985

    Google Scholar 

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Fedorak, R.N., Field, M. Antidiarrheal therapy. Digest Dis Sci 32, 195–205 (1987). https://doi.org/10.1007/BF01297108

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