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PubMed2000

Comparison of the antidiarrheal effects of zaldaride maleate and its optical isomers in rats.

Zaldaride maleate (ZAL), a calmodulin inhibitor, that ameliorates secretory diarrhea in rodents, has a racemic structure. In this study, we compared the antidiarrheal and antisecretory effects of ZAL and its optical isomers, R(-)-isomer and S(+)-isomer, in rats. In Ussing chamber experiments, the inhibitory action of ZAL on acetylcholine-induced ion transport in the rat colonic mucosa was equipotent for both optical isomers, with IC50 values of approximately 3--4 micromol/l. In castor-oil-induced diarrhea, ZAL and its S(+)-isomer inhibited the incidence of diarrhea, whereas the R(-)-isomer had no effect. In 16,16-dimethyl prostaglandin E2-induced diarrhea, ZAL, the S(+)-isomer and the R(-)-isomer significantly ameliorated diarrhea at doses of 30, 10 and 30 mg/kg (p.o.), respectively; the ED50 values were 25, 10 and above 30 mg/kg (p.o.), respectively. The pharmacokinetic parameters after administration of 30 mg/kg (p.o.) of each compound were as follows: ZAL (Cmax: 378 ng/ml, AUC0-12: 1650 ng-h/ml); S(+)-isomer (Cmax: 565 ng/ml, AUC0-12: 2230 ng-h/ml) and R(-)-isomer (Cmax: 271 ng/ml, AUC0-12: 613 ng-h/ml) (mean, N=4). In conclusion, despite the fact that the antisecretory actions of ZAL and its optical isomers are the same, the antidiarrheal actions of ZAL and its S(+)-isomer are more potent than that of the R(-)-isomer. The antidiarrheal actions of ZAL and its optical isomers may be related to plasma levels.

Animals↗
PubMed2003

Antidiarrheal drug products for over-the-counter human use; final monograph. Final rule.

The Food and Drug Administration (FDA) is issuing a final rule in the form of a final monograph establishing conditions under which over-the-counter (OTC) antidiarrheal drug products (to control the symptoms of diarrhea) are generally recognized as safe and effective and not misbranded. This final rule is part of FDA's ongoing review of OTC drug products. FDA is issuing this final rule after considering public comments on the agency's proposed regulation, which was issued in the form of a tentative final monograph (TFM), and all new data and information on OTC antidiarrheal drug products that have come to the agency's attention. Also, this final rule amends the regulation that lists nonmonograph active ingredients by adding those OTC antidiarrheal active ingredients that have been found to be not generally recognized as safe and effective.

Antidiarrheals↗
PubMed1984

Loperamide: blockade of calcium channels as a mechanism for antidiarrheal effects.

The antidiarrheal opiates loperamide, fluperamide, diphenoxylate and fetoxylate inhibited binding of [3H]nitrendipine to membranes from guinea-pig cerebral cortex with Ki values of 0.5 to 10 microM. Loperamide and fluperamide reversed the tiapamil elicited lowering of [3H]nitrendipine binding with IC50 values of 0.2 to 0.5 microM, indicating a verapamil-like action of these drugs. An oral dose of 1 mg/kg of loperamide reduced gastrointestinal motility and gave concentrations of 0.45 +/- 0.19, 0.38 +/- 0.22 and 0.49 +/- 0.25 microM in the duodenum, jejunum and ileum, respectively. The apparent Ki for loperamide in preventing calcium-induced contractions of guinea-pig ileum depolarized with 80 mM potassium was 0.10 microM. We propose that calcium channel antagonism is responsible at least in part for the antidiarrheal actions of loperamide and related agents. Evidence includes the calcium antagonist actions of loperamide at antidiarrheal doses, the constipating effects of certain calcium antagonists and the failure of opiate antagonists to prevent some intestinal effects of loperamide.

Animals↗
PubMed1984

Mechanism of the antidiarrheal effect of loperamide.

To determine whether the antidiarrheal effect of loperamide is due to an effect on intestinal motor function or to an acceleration of the rate of absorption by the intestine (as has been suggested recently), we studied absorption during experimental diarrhea produced by the rapid intragastric infusion of electrolyte solution. In studies in which a 2700-ml bolus of electrolyte solution was infused into the stomach over 90 min, loperamide delayed the appearance of rectal effluent in each of 5 subjects and decreased the volume of rectal effluent from 1090 +/- 118 to 770 +/- 73 ml (p = 0.05). When intragastric infusion was continued for 5 h, producing steady-state total gut perfusion, the volume of effluent produced per unit time and the concentration of a nonabsorbable polyethylene glycol marker in rectal effluent was not different with or without loperamide, indicating that loperamide did not alter the rate of absorption by intestinal mucosal cells. Loperamide also had no effect during steady-state perfusion when absorption rates were reduced by intravenous infusion of vasoactive intestinal polypeptide. Loperamide did substantially increase the intraluminal volume of the total gut, from 985 +/- 131 to 1764 +/- 195 ml (p less than 0.02). These results suggest that loperamide exerts its antidiarrheal effect by a change in the motor function of the intestine, which results in increased capacitance of the gut and a delay in the passage of fluid through the intestine. This change in motor function, rather than a change in the rate of absorption by intestinal mucosal cells, is responsible for the antidiarrheal effect of loperamide in our experimental diarrhea model.

Adult↗
PubMed1981

Nonnarcotic antidiarrheal action of clonidine and lofexidine in the rat.

Clonidine (0.01 to 0.16 mg/kg) and lofexidine (0.01 to 0.64 mg/kg) produced a dose-dependent inhibition of diarrhea induced by castor oil treatment in the rat. Both drugs were more potent and longer acting than diphenoxylate. Pre- and posttreatment with naloxone (5 mg/kg) failed to prevent or antagonize the antidiarrheal effect of clonidine and lofexidine. These data suggest that clonidine and lofexidine may provide potent antidiarrheal activity of a nonnarcotic nature.

Animals↗
PubMed2005

In vivo pharmacology and antidiarrheal efficacy of a thiazolidinone CFTR inhibitor in rodents.

A small-molecule inhibitor of the cystic fibrosis transmembrane conductance regulator (CFTR), 3-[(3-trifluoromethyl)phenyl]-5-[(4-carboxyphenyl)methylene]-2-thioxo-4-thiazolidinone (CFTR(inh)-172), reduces enterotoxin-induced intestinal fluid secretion in rodents. Here, we study CFTR(inh)-172 pharmacology and antidiarrheal efficacy in rodents using (14)C-labeled CFTR(inh)-172, liquid chromatography/mass spectrometry, and a closed intestinal loop model of fluid secretion. CFTR(inh)-172 was cleared primarily by renal glomerular filtration without chemical modification. CFTR(inh)-172 accumulated in liver within 5 min after intravenous infusion in mice, and was concentrated fivefold in bile over blood. At 30-240 min, CFTR(inh)-172 was found mainly in liver, intestine, and kidney, with little detectable in the brain, heart, skeletal muscle, or lung. Pharmacokinetic analysis in rats following intravenous bolus infusion showed a distribution volume of 770 mL with redistribution and elimination half-times of 0.14 h and 10.3 h, respectively. CFTR(inh)-172 was stable in hepatic microsomes. Closed-loop studies in mice indicated that a single intraperitoneal injection of 20 microg CFTR(inh)-172 inhibited fluid accumulation at 6 h after cholera toxin by >90% in duodenum and jejunum, approximately 60% in ileum and <10% in colon. No toxicity was seen after high-dose CFTR(inh)-172 administration (3 mg/kg/day in two daily doses) in mice over the first 6 weeks of life. The metabolic stability, enterohepatic recirculation, slow renal elimination, and intestinal accumulation of CFTR(inh)-172 account for its efficacy as an antidiarrheal.

Animals↗
PubMed1979

Decreased tetracycline bioavailability caused by a bismuth subsalicylate antidiarrheal mixture.

Oral coadministration of a single 250-mg tetracycline capsule and 60 ml of a bismuth subsalicylate antidiarrheal mixture reduced tetracycline absorption by 34% without appearing to perturb its absorption or disposition rate. A pronounced increase in intersubject tetracycline absorption variability also was noted. Apparently, the reduction in tetracycline bioavailability previously reported with a kaolin-pectin suspension is not peculiar to kaolin-pectin but can be expected with almost any antidiarrheal whose mechanism of action is adsorptive in nature.

Adult↗
PubMed1975

The antidiarrheal action of bismuth subsalicylate in the mouse and the rat.

The antidiarrheal effectiveness of bismuth subsalicylate was determined in two species of laboratory animals. Doses of castor oil were, at first, found to accelerate significantly the movement of a charcoal test meal along the small intestine of the mouse and rat and also to increase both the fecal output (dry or wet weight) and the frequency of diarrhea in mice. Bismuth subsalicylate significantly prevented the enhancement of charcoal-meal transport induced by castor oil in both mice and rats. Increased fecal outut (dry or wet weight) and increased frequency of diarrhea in mice were also significantly reduced by bismuth subsalicylate in a dose-related fashion. The findings in these experiments lead to the definitive conclusion that bismuth subsalicylate exerts antidiarrheal activity in the mouse and in the rat and support its use in therapy of common clinical diarrheal states.

Animals↗
PubMed1987

Antidiarrheal therapy. Prospects for new agents.

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.

Antidiarrheals↗
PubMed1990

Normalization of small intestinal propulsion with loperamide-like antidiarrheals in rats.

Gastrointestinal propulsion and the presence of diarrhea were assessed in rats pretreated with various opioids and challenged orally with either castor or paraffin oil, which both contained phenol red as a marker of gastrointestinal propulsion. In solvent-pretreated rats, diarrhea was always observed within 90 min after castor oil, reflecting a state of hyperpropulsive activity of the gut, but never (up to 8 h) after paraffin oil, reflecting normal intestinal propulsion (which amounted to an average distance of 91% of the total length of the small intestine in 90 min). Paraffin oil propulsion was blocked (to values less than 60%) by all opioids tested with the exception of the gut-selective compounds loperamide, loperamide oxide and fluperamide oxide (ED50s: greater than or equal to 160 mg/kg). Castor oil diarrhea was antagonized by all opioids tested and, at comparable but slightly (1.3-2.6 times) higher doses, propulsion was normalized to values (less than 100%) comparable to those measured in paraffin oil-challenged control rats. Castor oil propulsion was further reduced to subnormal values (less than 60%) by still higher doses of the opioids, comparable to those that blocked propulsion after paraffin oil. However, the required dose increment varied consistently among the opioids tested and ranged, depending on gut selectivity, from a factor 2.3 times the antidiarrheal dose for narcotic analgesics such as pethidine and dextromoramide to greater than 300 for antidiarrheals such as loperamide, loperamide oxide and fluperamide oxide. Protection from diarrhea and normalization of propulsion showed a close correlation; both failed to correlate with central analgesic activity and are thought to be mediated via peripheral opioid receptors.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesics↗
PubMed2006

Oral administration of phenolic antidiarrheic ingredients prevents ovariectomy-induced bone loss.

In the present study, we have attempted to evaluate the pharmacological actions of three major phenolic antidiarrheic ingredients, including 2-methoxyphenol (2MP), 2-methoxy-4-methylphenol (2M4MP) and 2-methoxy-4-ethyphenol (2M4EP), on the functionality and integrity of bone by in vitro and in vivo experimental techniques. Intermittent oral administration of 2M4MP and 2M4EP, but not 2MP, significantly prevented reductions of bone mineral density in total femur, distal femur and tibia, in addition to alterations of several osteoclastic parameters on histomorphometric analysis, when determined 28 days after ovariectomy in mice. All three phenolic ingredients examined significantly inhibited the developmental increase in the number of multinucleated cells positive to tartrate-resistant acid phosphatase staining in cultured mouse osteoclasts differentiated from bone marrow precursors in the presence of both macrophage-colony stimulating factor and receptor activator of nuclear factor-kappaB ligand, which occurred in a concentration-dependent manner at a concentration range of 1 microM-1mM without inducing cell death. Moreover, both 2M4MP and 2M4EP at 1mM not only prevented the cell death induced by 0.5mM H2O2 in cultured rat calvarial osteoblasts, but also suppressed the generation of intracellular reactive oxygen species in osteoblasts exposed to H2O2, with a radical scavenging action as revealed by electron spin resonance analysis. These results suggest that particular phenolic antidiarrheic ingredients may prevent ovariectomy-induced bone loss through a mechanism related to the inhibition of osteoclastogenesis in association with an anti-oxidative property in osteoblasts.

Administration, Oral↗
PubMed2004

Multicenter, double-blind, randomized comparison of wood creosote, the principal active ingredient of Seirogan, an herbal antidiarrheal medication, and loperamide in adults with acute nonspecific diarrhea.

BACKGROUND: Seirogan, an herbal medication containing wood creosote, a mixture of simple phenolic (single-ring)compounds, has been marketed in Asia for the past century as an antidiarrheal and antispasmodic medication. This was the first randomized, double-blind study of this herbal medication in patients with acute, nonspecific diarrhea. OBJECTIVE: The aim of this study was to compare the efficacy and tolerability of wood creosote with those of loperamide hydrochloride in patients with acute, nonspecific diarrhea. METHODS: This double-blind, randomized, active-controlled study was conducted at 12 centers across the United States and Mexico. Patients aged >or=18 years with acute, nonspecific diarrhea, defined as a history of diarrhea for or=3 unformed stools in the 24 hours before the study, accompanied by >or=1 associated symptom (ie, nausea, vomiting, abdominal cramping, and/or fever [<or=101.0 degrees F or <or=38.3 degrees C]), were eligible for the study Patients received wood creosote 135 mg (<or=5 doses/d) or loperamide 4 mg (loading dose) followed by 2 mg (<or=8 mg/d) after each loose stool for <or=3 days. The primary efficacy end point was the time to the last unformed stool (TTLUS). Clinical safety laboratory tests and patient diaries were used to assess tolerability. RESULTS: One hundred twenty-three patients (74 women, 49 men; mean [SD] age, 42.6 [14.9] years; age range, 18-90 years) were randomized to receive wood creosote (n = 60) or loperamide (n = 63). Eighty-four of the 123 enrolled patients (68.3%) were Hispanic, 18 (14.6%) white, 17 (13.8%) black, and 4 (3.3%) Asian or Pacific Islander. The majority of patients (88.3% in the wood creosote group and 95.2% in the loperamide group) had abdominal cramping as the predominant associated symptom. The median (interquartile range [IQR]) TTLUS was similar between groups (24.4 [6.3-36.8] and 22.1 [3.5-32.1] hours in the wood creosote and loperamide groups, respectively), as was the median (IQR) time to total relief (31.0 [15.7-47.8] and 28.5 [13.5-43.5] hours in the wood creosote and loperamide groups, respectively). The mean (SD) numbers of unformed stools on day 1 were 3.31 (2.15) and 2.22 (1.25) in the wood creosote and loperamide groups, respectively (P < 0.002). The percentages of patients with improved or resolved abdominal cramping at the end of day 1 were 92.5% (49/53) and 78.0% (46/59) in the wood creosote and loperamide groups, respectively (P < 0.038). Both medications were well tolerated in the population studied. CONCLUSIONS: Wood creosote and loperamide had comparable antidiarrheal effects in these patients with acute, nonspecific diarrhea. Wood creosote appeared somewhat more efficacious in improving or resolving abdominal cramping, whereas loperamide appeared somewhat more efficacious in improving diarrhea. Both treatments were well tolerated.

Adolescent↗
PubMed1998

Experimental study of antidiarrheal activity of Salicairine.

Experimental antidiarrheal activity of a traditionally used medication, Salicairine, was demonstrated in comparison to loperamide by significant inhibition of castor oil-induced diarrhea in mice (increases in hard faeces/total faeces ratio of 38 and 54 and 5 and 54% with respect to controls, at 0.5 and 1 mL/kg and 1 and 2 mg/kg, respectively) and bisacodyl-induced increase in large intestine transit in rats (125 and 280 and 210% with respect to controls, at 0.4 and 2 mL/kg Salicairine and 5 mg/kg loperamide, respectively). Salicairine was able to reduce contractions of isolated rat duodenum induced by barium chloride and acetylcholine, although not completely (that is about 60%) as seen with loperamide. Also, it did not change normal gastrointestinal transit in mice at doses of 0.5 to 1 mL/kg, conversely to loperamide which had a significant effect (decrease of 50%) at 2 mg/kg. Finally, Salicairine at 0.01 mL/mL, like loperamide at 0.2 mg/mL, significantly increased net fluid absorption in rat colon, either in basal conditions (30 and 64% respectively) or after a prostaglandin E1-induced increase in net fluid secretion (41 and 35%, respectively). The antidiarrheal activity of Salicairine is possibly related, at least in part, to an increase in colon net fluid absorption or a decrease in net fluid secretion.

Acetylcholine↗
PubMed1993

Demonstration of antidiarrheal and antimotility effects of wood creosote.

Wood creosote administered to rats prevented castor-oil-induced diarrhea with an ED50 of 53 mg/kg p.o. This antidiarrheal effect was apparently produced by acceleration of net fluid absorption from the intestine, as shown by a 52% decrease (p < 0.001) of residual fluid volume in an intestinal loop, and partly by suppression of intestinal motility. Wood creosote also inhibited spontaneous longitudinal contractions of isolated ileal segments in rats (IC50 = 28 mg/l) and guinea pigs (IC50 = 17 mg/l). Contractions of the guinea pig ileum induced by electrical stimulation, bradykinin and acetylcholine were also inhibited dose-dependently. We conclude that wood creosote has an antidiarrheal activity and that this effect is exerted by inhibition of intestinal motility and by augmentation of net fluid absorption from the intestine.

Acetylcholine↗
PubMed2003

Multiple-dose escalation, safety, and tolerability study of wood creosote, the principal active ingredient of seirogan, an herbal antidiarrheal medication, in healthy subjects.

Seirogan, an herbal medicine containing wood creosote (CAS 8021-39-4), a mixture of simple phenolic compounds, has been marketed for the past century in Asia for the treatment of acute diarrhea and associated symptoms, such as abdominal discomfort and cramping. The present study was designed to assess the safety and tolerability of an anticipated acute antidiarrheal dosing regimen. Sixty healthy males were randomized into five groups of 12 subjects each (9 wood creosote; 3 placebo) to receive 45-, 90-, 135-, 180-, and 225-mg tablets every 2 hours for five doses. Serial sitting and standing vital signs, ECG rhythm strips, and continuous telemetry monitoring were obtained predose and for 24 hours after the first dose. Clinical laboratory tests and 12-lead resting ECGs were obtained predose and 24 hours postdose. Of the subjects, 27% (12/45) receiving wood creosote and 27% (4/15) receiving placebo reported adverse events. The most common adverse events were altered taste and somnolence, reported more often with 180- and 225-mg doses. Wood creosote had no clinically significant effects on vital signs, ECG intervals or interpretations, or clinical laboratory tests. No clinically significant or serious dysrhythmias were reported on continuous telemetry monitoring. It was concluded that oral doses of wood creosote 45 to 225 mg every 2 hours for up to five doses were safe and well tolerated in 45 healthy subjects. Wood creosote doses ranging from 45 to 135 mg per dose, which are commonly administered antidiarrheal doses in Asia, were associated with minimal side effects.

Administration, Oral↗
PubMed2000

Gender differences in the antidiarrheal effect of zaldaride maleate in rats.

The amelioration of secretory diarrhea has been reported after the administration of zaldaride maleate (ZAL), a selective calmodulin inhibitor, to male rodents. In this study, the antidiarrheal effect of ZAL in female rats was compared with that in male rats. In female and male rats, ZAL significantly ameliorated 16,16-dimethyl prostaglandin E2-induced diarrhea at doses of 1 and 3 mg/kg (p.o.), respectively, with ID50 values of 0.7 mg/kg (p.o.) in the females and 10.3 mg/kg (p.o.) in males. In castor oil-induced diarrhea, ZAL also significantly reduced the incidence of diarrhea in female and male rats at doses of 10 and 30 mg/kg (p.o.), respectively. When the same dose of ZAL was given orally to female and male rats, the maximum plasma level of this compound was approximately 3 times higher in female rats than in male rats. In contrast, after intravenous administration of the same dose of ZAL to female and male rats, the total clearance of this compound was similar. In an Ussing chamber experiment, the inhibitory action of ZAL on vasoactive intestinal polypeptide-induced ion secretion in the colon showed no difference between female and male rats. In conclusion, the antidiarrheal effect of ZAL in female rats is more potent than that in males, and could be due to the difference in plasma levels of this compound between female and male rats after oral administration.

16,16-Dimethylprostaglandin E2↗
PubMed2000

Comparison of the antidiarrheal effects of wood creosote and loperamide in the rat jejunum and colon in vitro.

Wood creosote, a mixture of guaiacol, creosol and related compounds, has long been used as an antidiarrheal agent. The goal of our study was to investigate the antisecretory effect of wood creosote and to compare it to the effect of loperamide, a synthetic opioid widely used in the treatment of diarrhea. Experiments were performed in rat jejunal and colonic mucosal sheets, mounted in modified Ussing chambers. Active electrogenic transport was monitored electrically as short circuit current (Isc) and hypersecretory responses were induced by acetylcholine (ACh). Neither loperamide nor wood creosote had any significant effect on basal lsc, when added to the serosal bathing solution at concentrations of 0.1-50microg/ml. In contrast, under hypersecretory conditions, both agents showed concentration-dependent (0.1--100microg/ml) antisecretory effects inhibiting ACh-induced responses in the jejunum and colon. However, the effects suggest regional differences, with loperamide being most potent in the jejunum, while wood creosote showed equal potency in both jejunum and colon. Based upon these in vitro findings, we conclude that like loperamide, the antidiarrheal action of wood creosote is due, at least in part, to its antisecretory activity.

Acetylcholine↗
PubMed2005

New views on antidiarrheal effect of wood creosote: is wood creosote really a gastrointestinal antiseptic?

Wood creosote, the principal ingredient in Seirogan, has a long history as a known gastrointestinal microbicidal agent. When administered orally, the intraluminal concentration of wood creosote is not sufficiently high to achieve this microbicidal effect. Through further animal tests, we have shown that antimotility and antisecretory actions are the principal antidiarrheal effects of wood creosote. Wood creosote inhibits intestinal secretion induced by enterotoxins by blocking the Cl(-) channel on the intestinal epithelium. Wood creosote also decreases intestinal motility accelerated by mechanical, chemical, or electrical stimulus by the inhibition of the Ca(2+) influx into the smooth muscle cells. In this overview, the antimotility and antisecretory effects of wood creosote are compared with those of loperamide. Wood creosote was observed to inhibit stimulated colonic motility, but not normal jejunal motility. Loperamide inhibits normal jejunal motility, but not stimulated colonic motility. Both wood creosote and loperamide inhibit intestinal secretion accelerated by acetylcholine. Wood creosote was found to have greater antisecretory effects in the colon than loperamide. Based upon these findings, we conclude that the antidiarrheal effects of wood creosote are due to both antisecretory activity in the intestine and antimotility in the colon, but not due to the microbicidal activity as previously thought. Wood creosote was found to have no effects on normal intestinal activity. These conclusions are supported by the results of a recent clinical study comparing wood creosote and loperamide, which concluded that wood creosote was more efficacious in relieving abdominal pain and comparable to loperamide in relieving diarrhea.

Animals↗