Effect of codeine phosphate, Lomotil, and Isogel on ileostomy function

Abstract

SUMMARYThe effect on ileostomy function of codeine phosphate, Lomotil, or Isogel was tested in 20 subjects at home living a normal life, studied over two three-day periods on and off treatment. Codeine phosphate 60 mg three times daily was associated with a reduction in the mean total weight of ileostomy output and the ileostomy outputs of water, sodium, and potassium (p < 0 05). The proportion of faecal solids increased on codeine and the effluent appeared thicker but the output of faecal solids remained unchanged. Mean.faecal fat increased on codeine. The transit rate from mouth to stoma was slower in four of the five subjects on codeine and a further two subjects withdrew from the trial with temporary intestinal obstruction while on the drug. Lomotil two tablets three times daily was associated with a small and statistically not quite significant fall in the mean total weight of ileostomy output and the ileostomy output of water. Sodium and potassium outputs in the effluent fell on Lomotil (p < 0 05) but the other parameters remained unchanged. Isogel 15 ml three times daily was associated with an increase in the mean total weight of ileostomy output and the ileostomy outputs of water, sodium, potassium, and faecal solids (p < 0-01). Although the effluent looked more viscid on Isogel, the proportion of faecal solids was unchanged. These results suggest that codeine phosphate has a beneficial effect on ileostomy function, reducing the loss of water and electrolytes, while Lomotil has a similar but less effective action in the dosage tested. By contrast, Isogel increases the ileostomy loss of water and electrolytes and will aggravate their depletion in patients with excessive fluid effluents. The increase in faecal fat associated with taking codeine phosphate suggests that it should be stopped before collecting specimens for faecal fat estimations.

Teduglutide, a novel glucagon-like peptide 2 analog, in the treatment of patients with short bowel syndrome

“…Oral rehydration solutions with a high sodium concentration are unpalatable, precluding their longterm use, and their effects on intestinal fluid and electrolyte absorption remain to be established in balance studies in patients with SBS and more severe intestinal failure [Nightingale et al 1992]. Agents such as codeine, loperamine and tincture of opium reduce intestinal motility but, again, their effects in patients with SBS and severe malabsorption remain to be established [Newton, 1978;Tytgat and Huibregtse, 1975;King et al 1982]. Antisecretory drugs, that is, H 2 -receptor antagonists [Cortot et al 1979;Jacobsen et al 1986], proton-pump inhibitors [Jeppesen et al 1998] or somatostatin analogs, reduce gastric acid secretions, jejunostomy wet weight output and diarrhea in patients with a preserved colon, but no effects on macronutrient absorption have been established [Cooper et al 1986;Rodrigues et al 1989;Ladefoged et al 1989;O'Keefe et al 1994].…”

Management of patients with a short bowel

“…Loperamide and codeine phosphate reduce intestinal motility and thus decrease water and sodium output from an ileostomy by about 20%-30% [93][94][95] . Loperamide is preferred to opiate drugs (e.g.…”

“…The addition of glutamine (15 gm) to a litre of rehydration solution in patients with jejunostomy resulted in no additional benefit in terms of water or sodium absorption [152] . The fibre content of the diet plays only a minor role in determining jejunal output [93] . As the stomal sodium losses are about 100 mmol·L -1 any diet will need added sodium chloride.…”

Oral Rehydration Therapy and Feeding Replaces Total Parenteral Nutrition: A Clinical Vignette

“…We did not use anti-motility medications, as they are marginally useful in enhancing absorption of water and electrolytes. 4 Feeding via the gastrostomy tube was begun and did not reduce salt and water losses, so it was stopped. There was no evidence of recurrence of C. difficile in her remaining ileum.…”