Medication/supplement | Comments |
Antidiarrheal agents | |
Loperamide 2 to 4 mg as needed. Not to exceed 16 mg/day. |
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Diphenoxylate-atropine (2.5/0.025 mg). 1 to 2 tablets after each loose stool. Not to exceed 8 tablets/day. |
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Deodorized tincture of opium 1% solution (contains 10 mg morphine per mL) 0.3 to 0.8 mL in water three times daily. |
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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. |
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Colestipol:
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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*. |
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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*. |
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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. |
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Vitamin D3 (cholecalciferol) 10,000 to 50,000 units (250 to 1250 mcg)/day individualized according to serum 25(OH)D level. |
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Vitamin K (phytonadione) 2.5 to 12.5 mg/day. |
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Folic acid 1 mg/day. | |
Vitamin B12 (cyanocobalamin) 1 mg subcutaneously or intramuscular, repeat 3 times in first week. Acute oral repletion not recommended. |
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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. |
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Ferrous sulfate 325 mg (65 mg elemental iron) three times daily. |
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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 drug monographs (included within 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 1997.
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