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GI Drugs


REMEMBER the PPI side effects
Decrease Ca absorption =  osteoporosis = Hip fracture
Decrease Vit B12 absorption
Increase risk of Community acquired pneumonia
Increase risk of C. Diff Colitis

Gastritis

  • Protonix 40 mg PO bid x 4 weeks, then 1 PO qd. #56
  • Carafate 10 ml (1 g) PO qid 1 hr before meals, bedtime x 2 weeks. #560ml
  • Pepcid 20, 40 mg PO, IV bid x 12wks #60, RF x 2
 

GI Cocktail

FORMULA ONE
  • Mylanta (60 cc)
  • Carafate (20 cc)
  • Viscous Lidocaine (15 cc)
    • 95 ml x 1

 

FORMULA TWO
  • Donnatal (10 cc)
  • Viscous Lidocaine (10 cc)
  • Mylanta (30 cc)
    • 50 ml x 1

 

Magic Mouth Wash for oral ulcers:

Sig: Swish, gargle & spit 5-10ml q6h prn

1)
 
80 ml viscous lidocaine 2%
80ml mylanta 
80ml diphenhydramine 12.5/5 elix
80ml nystatin 100,000U susp
80ml prednisolone 15/5 solu
80ml distilled water

2) 
1 part viscous lidocaine 2%
1 part Maalox
1 part diphenhydramine 12.5/5 elix

3) 
30ml Viscous lidocaine 2%
60ml Maalox (don't substitute) 
30ml diphenhydramine 12.5/5 elix
40ml carafate 1gm/10ml 

4)
100ml dexamethasone 0.5mg/5ml elixir 

5)
Erythromycin 125 mg/ml (60 cc)
Kenalog 40mg/ml (2 cc)
Benadryl (60 cc)
Carafate 2-4 grams

6)
Nystatin Liquid (60 cc)
Kenalog (2 cc)
Benadryl (60 cc)
2% Viscous Lidocaine (60 cc)

 

Constipation

Medication Usual adult dose Onset of action Side effects
Bulk-forming laxatives*
Psyllium Up to 1 tablespoon (≅3.5 grams fiber) 3 times per day 12 to 72 h Impaction above strictures, fluid overload, gas and bloating
Methylcellulose Up to 1 tablespoon (≅2 grams fiber) or 4 caplets (500 mg fiber per caplet) 3 times per day 12 to 72 h
Polycarbophil 2 to 4 tabs (500 mg fiber per tab) per day 24 to 48 h
Wheat dextrin 1 to 3 caplets (1 gram fiber per caplet) or 2 teaspoonsful (1.5 gram fiber per teaspoon) up to 3 times per daily 24 to 48 h
Surfactants (softeners)
Docusate sodium 100 mg 2 times per day 24 to 72 hours Well tolerated. Use lower dose if administered with another laxative. Contact dermatitis reported.
Docusate calcium 240 mg 1 time per day 24 to 72 hours
Osmotic agents
Pedia-Lax Enema:
  • 2-4 yo: 1/2 bottle (29.5 ml) PR qd prn
  • 5-11 yo: 1 bottle (59 ml) PR qd prn
   
Polyethylene glycol (macrogol) 8.5 to 34 grams in 240 mL (8 ounces) liquids 1 to 4 days Nausea, bloating, cramping
Lactulose 10 to 20 grams (15 to 30 mL) every other day. May increase up to 2 times per day. 24 to 48 hours Abdominal bloating, flatulence
Sorbitol 30 grams (120 mL of 25 percent solution) 1 time per day 24 to 48 hours Abdominal bloating, flatulence
Glycerin (glycerol) One suppository (2 or 3 grams) per rectum for 15 minutes 1 time per day 15 to 60 minutes Rectal irritation
Magnesium sulfate One to two teaspoonsful (5 to 10 grams) dissolved in 240 mL (8 ounces) water 1 time per day 0.5 to 3 hours Watery stools and urgency. Caution in renal insufficiency (magnesium toxicity).
Magnesium citrate 200 mL (11.6 grams) 1 time per day 0.5 to 3 hours
Stimulant laxatives
Bisacodyl 10 to 30 mg as enteric coated tabs 1 time per day 6 to 10 hours Gastric irritation
10 mg suppository per rectum 1 time per day 15 to 60 minutes Rectal irritation
Senna 2 to 4 tabs (8.6 mg sennosides per tab) or 1 to 2 tabs (15 mg sennosides per tab) as a single daily dose or divided twice daily 6 to 12 hours Melanosis coli
Other
Lubiprostone 24 micrograms 2 times per day 24 to 48 hours Nausea, diarrhea
Linaclotide 145 micrograms 1 time per day 12 to 24 hours Diarrhea, bloating

 

 

 

IBS

Constipation-Predominant Diarrhea-Predominant Alternating
W/O pain & bloating W/ Pain & Bloating W/O Pain & Bloating W/ Pain & Bloating W/O Pain & Bloating W/ Pain & Bloating
Psyllium : (2.4 g of soluble dietary fiber per dose) one dose orally in a glass of water, up to three times daily

Lactulose
: 10-20 g (or 15-30 mL) orally once daily, can increase to twice daily or three times daily if no response, Max: 40 g/day (or 60 mL/day)

Amitiza (Iubipostone): 24 micrograms orally twice daily

Linzess (linaclotide) : 290 micrograms orally once daily

Psyllium
Lactulose

GoLytely

Anti-Spasmodic:

Dicyclomine : 10-20 mg orally four times daily when required

Levsin (Hyoscymine) : 0.125 to 0.25 mg orally/sublingually three to four times daily when required, maximum 1.5 mg/day.
Peppermint oil (Mentha x piperita) : one dose (0.2 mL of peppermint oil) orally three times daily; consult product literature for further guidance on dose

SSRI:
Paroxetine : 20-40 mg orally once daily
Citalopram
: 20-40 mg orally once daily
--
Linzess
(linaclotide) :

Anti-Diarrheals:
Loperamide
: 2-4 mg orally initially, followed by 2 mg after each loose stool when required, maximum 16 mg/day
Cholestyramine : 2-4 g orally two to four times daily
Lotronex (alosetron) : 0.5 to 1 mg orally twice daily
Psyllium
Lactulose

GoLytely

Loperamide

Anti-Spasmodic:
Dicyclomine
Levsin (Hyoscymine)
Peppermint oil (Mentha x piperita)

Psyllium
Lactulose

GoLytely (polyethylene glycol/electrolytes)

Loperamide

TCA anti-depressants:
Desipramine
: 10-25 mg orally once daily at bedtime
Amitriptyline : 10-25 mg orally once daily at bedtime
Doxepin : 25-75 mg orally once daily at bedtime

SSRI:
Paroxetine : 20-40 mg orally once daily
Citalopram : 20-40 mg orally once daily
  Rifaximin : 550 mg orally three times daily for 14 days

Anti-Spasmodic:
Dicyclomine :
Levsin (Hyoscymine) :
Peppermint oil (Mentha x piperita) :

TCA anti-depressants:
Desipramine
: 10-25 mg orally once daily at bedtime
Amitriptyline : 10-25 mg orally once daily at bedtime
Doxepin : 25-75 mg orally once daily at bedtime

  • Amitiza (Iubipostone)
    • Chronic consitpation: 24 mcg PO bid
    • Opioid-induced constipation: 24 mcg PO bid
    • IBS, Constipation predominant: 8 mcg PO bid
  • Levsin (Hyoscymine) [SL, SC, IM, IV]
    • GI tract spasm: 0.125-0.25 mg PO/SL q4h prn
    • Bladder spams: 0.125-0.25 mg PO/SL q4h prn
    • IBS, adjunct tx: 0.125-0.25 mg PO/SL q4h prn
    • PUD, adjunct tx: 0.125-0.25 mg PO/SL q4h prn
  • Dicyclomine [10,20]
    • 20-40 mg PO qid
  • Donnatal (phenobarbital/hyoscyamine/atropine/scopolamine)
    • IBS: 1-2 tabs PO q6-8h
    • Acute enterocolitis: 1-2 tabs PO q6-8h
    • Duodenal ulcer: 1-2 tabs PO q6-8h
  • Linzess (linaclotide) [145, 290 mcg]
    • IBS: 290 mcg PO qd
    • Chronic idiopathic consitpation: 145 mcg PO qd
  • Zelnorm (tegaserod)
    • WITHDRAWN FROM US MARKET 2007