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Loperamide in rat intestines: a unique disposition.

When everted sacs of rat duodenum, jejunum and ileum were incubated with [14C]loperamide in vitro, unchanged drug and its metabolites were found not only in tissues but also in media of the mucosal side with virtually no radioactivity in media of the serosal side. The amounts of metabolites found in media of the mucosal side were comparable to or larger than those in tissues. Di-desmethyl loperamide was more predominant in the media as compared with mono-demethylated one than in the tissues. Therefore, a portion of loperamide absorbed in intestines can be metabolized there and directly secreted back into lumen. Oral loperamide thus undergoes a unique disposition, likely constituting one of mechanisms for its distinct dissociation of central and antidiarrheal activities.

Animals↗

Effects of selective opioid agonists on feline colonic transit.

The mu agonist morphine and the non-specific opioid antagonist naloxone both may accelerate feline colonic transit; the effects of morphine are dose dependent. Kappa and delta receptor function was studied in the present work. Colonic transit of a radionuclide marker instilled into the cecum was quantitated for 6 hr in a crossover study. The delta agonist [D-Pen2,D-pen5]enkephalin (1 mg/kg, i.m.) prolonged the cecum and ascending colon half-emptying time by 337% (P less than 0.05), and delayed the progression of the geometric center over time. The kappa agonist U-50,488 (1 mg/kg, i.m.) had no apparent effect on the cecum and ascending colon, but delayed filling of the descending colon. Loperamide, an antidiarrheal agent, also delayed colonic transit. Thus, selective opioid agonists have both site and functional differences in their effect on feline colonic transit.

3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cycloh↗

Opiate binding sites in mucosa of pig small intestine.

Opiates such as morphine have profound antidiarrheal and constipating actions due in part to their ability to modify intestinal ion transport. This study was undertaken to examine the presence of opiate binding sites in the porcine distal jejunum, a gut segment analogous to the human ileum. Specific binding sites for the tritiated, mu-selective opioid agonist [D-Ala2, N-Me-Phe4, Gly5-ol]enkephalin (DAMGO) were localized to the basal portion of villous and crypt cells of the intestinal epithelium by receptor autoradiography. These binding sites may represent enkephalin receptors capable of modulating active electrolyte transport.

Animals↗

Loperamide effects on hepatobiliary function, intestinal transit and analgesia in mice.

Loperamide effects on hepatobiliary function, analgesia and gut transit were studied in mice. Varying doses of the antidiarrheal drug, loperamide, were administered to mice by intracerebroventricular, intravenous, subcutaneous and intragastric routes. Gut motility was determined by intestinal transit of India ink, analgesia by warm water tail flick latency, and hepatobiliary function by retention of the anionic dye, sulfobromophthalein in plasma and liver. When given by all routes at modest doses, loperamide slowed intestinal transit. Analgesia, a centrally mediated opiate effect, was only detected after intracerebroventricular or subcutaneous loperamide at high, near-toxic doses. Elevations of plasma and liver sulfobromophthalein were noted at routes and doses which slowed gut transit, well below those needed for analgesia. Intragastric loperamide at one fortieth its LD50 caused marked elevation of sulfobromophthalein levels and gut slowing, but no analgesia. Sulfobromophthalein elevation and gut slowing by intragastric loperamide were not affected by spinal cord transection but were reversed by naltrexone, an opiate antagonist. Non-toxic doses of loperamide slow gut transit and modify hepatobiliary function in mice by opiate actions at peripheral sites.

Administration, Oral↗

Prevention of cecitis in hamsters by certain prostaglandins.

Acute inflammation of the colon (cecitis) was produced in hamsters by daily subcutaneous administration of an antibiotic for 3 days. The following prostaglandins completely prevented the cecitis: 16,16-dimethyl-PGE2, 15(R)-15-methyl-PGE2, and 2-acetyl-2-decarboxy-15(S)-15-methyl-PGF2 alpha. PGF2 beta was less active. The synthesis of 2-acetyl-2-decarboxy-15(S)-methyl-PGF2 alpha is described. Castor oil also prevented the cecitis and peanut oil exerted partial protection. Since these oils contain linoleic acid, a precursor of PGE1, protection may have been due to endogenous formation of that prostaglandin. A partial block of the protective effect of castor oil by treatment with indomethacin supports such mechanism. The tissue level of endogenous prostaglandins seems to exert protection since administration of cyclooxygenase inhibitors, indomethacin and aspirin, markedly increased the incidence of cecitis. Magnesium sulfate given orally and sodium salicylate given subcutaneously reduced the incidence of cecitis only partially. The following agents were inactive: loperamide, an antidiarrheic agent; carbachol, a cholinergic and diarrheogenic agent, atropine, an anticholinergic agent; and acetazolamide, a carbonic anhydrase inhibitor. These results, show that certain prostaglandins, which have been shown earlier to be cytoprotective for the stomach and the small intestine, are cytoprotective for the large intestine as well.

Animals↗

Rectal J pouch reservoir to decrease the frequency of tenesmus and defecation in low coloproctostomy.

Low anterior resection of the colon with very low coloproctostomy is a procedure occasionally required in the surgical management of the patient with gynecologic malignancy. Very low end-to-end anastomosis of the colon to rectum has been associated with fecal frequency and tenesmus in up to 70% of cases. The construction of a rectal J-pouch low-pressure reservoir has been reported to have a salutary effect upon these symptoms. Between March 1987 and January 1988 a pilot study was carried out in which six patients with primary or recurrent gynecologic malignancy who underwent low anterior resection of the colon requiring very low coloproctostomy (below 6 cm) had construction of a rectal J-pouch reservoir with a Strasbourg-Baker end-to-side coloproctostomy. No postoperative complications were noted in this small series of patients. No patient has had more than three stools per day since surgery. Antidiarrheal medication was not required. All patients denied tenesmus. It was concluded that the rectal J-pouch reservoir offered a surgical technique for avoiding tenesmus and fecal frequency in very low end-to-end anastomosis of colon to rectum.

Anastomosis, Surgical↗

Rectal J-pouch reservoir to decrease the frequency of tenesmus and defecation in low coloproctostomy.

Low anterior resection of the colon with very low coloproctostomy is a procedure occasionally required in the surgical management of the patient with gynecologic malignancy. Very low end-to-end anastomosis of the colon to the rectum has been associated with fecal frequency and tenesmus in up to 70% of cases. The construction of a rectal J-pouch low-pressure reservoir has been reported to have a salutary effect on these symptoms. Between March 1987 and April 1988, a pilot study was carried out in which 11 patients with primary or recurrent gynecologic malignancy who underwent low anterior resection of the colon requiring very low coloproctostomy (below 6 cm) had construction of a rectal J-pouch reservoir with a Strasbourg-Baker end-to-side coloproctostomy. No postoperative complications were noted in this small series of patients. No patient has had more than three stools per day since surgery. Antidiarrheal medication was not required. All patients denied tenesmus. It was concluded that the rectal J-pouch reservoir offered a surgical technique for avoiding tenesmus and fecal frequency in very low end-to-end anastomosis of colon to rectum.

Adult↗

The use of a compact protable microcomputer system (EPSON HX 20) to measure on-line the contractile activity of the digestive tract from eight channels. Application to pharmacological tests.

The chronically prepared gut with strain-gauge transducers is a useful model to evaluate the effects of drugs affecting the digestive motility in fed and fasted animals. This paper describes a rapid and reproducible on-line microcomputerized technique to evaluate continuously, 23 hr per day, the level of gut motility using a portable compact microcomputer (EPSON HX 20). The gastric, intestinal, and colonic motility indexes were automatically determined from the surface of the contractile waves from eight different sites over periods of time varying from 1 to 120 min. This system has been successfully used to investigate the motor effects of spasmolytic or antidiarrheal drugs inravenously (N-butyl-hyoscine, trospium, secoverine, and prifinium) or orally (trimebutine, loperamide) administered in conscious, fed dogs.

Animals↗

Neutral endopeptidase 24.11 in rat peripheral tissues: comparative localization by 'ex vivo' and 'in vitro' autoradiography.

The neutral endopeptidase 24.11 (NEP) also called 'enkephalinase' thanks to its inactivation of enkephalins in the brain, was also recently shown to be involved in the degradation of the circulating atrial natriuretic peptide (ANP). Inhibitors of NEP are therefore under clinical trials as new analgesics or antidiarrheal agents, protecting centrally or peripherally released opioid peptides and as novel antidiuretics and anti-hypertensives in prolonging the renal and vascular actions of NEP. It was therefore important from a clinical point of view to investigate the distribution in peripheral tissue of a systemically administered NEP blocker. Different concentrations of the radiolabelled inhibitor [3H]HACBO-Gly have been intravenously injected in rat and the distribution studied using whole-body sections at different times by 'ex vivo' and 'in vitro' autoradiography to investigate differences in tissue accessibility of NEP to a circulating inhibitor. In vivo [3H]HACBO-Gly binding was fully prevented by an excess of unlabelled inhibitor and disappeared rapidly mainly through renal elimination. NEP labelling was prominent in kidney, liver, lung, fat deposits in the neck region, the flat bones of the skull, the mandibula, the vertebrae, the long bones of the limbs, articular cartilages and synoviae. A lower labelling was found in the intestine, the glomeruli and the submaxillary glands. [3H]HACBO-Gly binds also to a limited number of peripheral tissues in which the presence of NEP was yet unknown (bones, parts of adipose tissues. Some tissues, not labelled in vivo, exhibited various degrees of labelling under in vitro conditions (the brain, some portions of the gut, the testes, the prostate). Interestingly, few lobules of the submaxillary glands were much more densely labelled suggesting the possible occurrence of NEP heterogeneity. Except for the brain, the physiological function of NEP in various tissues remains largely unknown, but this ectoenzyme is likely involved in inactivation of regulatory peptides such as: ANP (partially in the kidney), SP in the lung and possibly somatostatin and ANP in bone, ANP in adipose tissue, enkephalin in testes, immune peptidic factors in bone marrow. A part of NEP in bone marrow corresponds probably to the common acute lymphoblastic antigen, CALLA, densely expressed on pre-B cells. Finally, it is important to notice that several tissues containing important concentrations of NEP (brain, testes, prostate, eye, gut, brush border) are inaccessible to the i.v. injected inhibitor thanks to the presence of functional barriers.

Animals↗

In vivo inhibitory effect of lanreotide (BIM 23014), a new somatostatin analog, on prostaglandin- and cholera toxin-stimulated intestinal fluid in the rat.

The antisecretory action of subcutaneously (SC) administered somatostatin(1-14), octreotide, and lanreotide on jejunal net flux of water under basal, prostaglandin E1 (PGE1)- and cholera toxin (CT)-stimulated secretory conditions was determined in vivo on isolated intestinal loop in anesthetized rats. Both PGE1 and CT induced intestinal hypersecretion in the rats. This secretory effect was not affected by SC administration of saline. Lanreotide (1, 10, and 100 micrograms/kg) reduced the maximal PGE1-induced secretion, while 200 micrograms/kg had no effect. Similarly, octreotide (1 and 10 micrograms/kg) and somatostatin (1-14) (0.1 and 1 microgram/kg) reduced the increase of net water flux induced by PGE1. However, higher doses of octreotide (100 and 200 micrograms/kg) and somatostatin(1-14) (10 and 100 micrograms/kg) had no effect on PGE1-induced secretion. Lanreotide, octreotide, and somatostatin(1-14) (1 and 10 micrograms/kg) abolished the maximal secretion induced by cholera toxin. However, 100 micrograms/kg of lanreotide, octreotide, and somatostatin(1-14) had no effect on cholera toxin-induced secretion. The present study shows that lanreotide, octreotide, and somatostatin(1-14) reduce the secretion induced by PGE1 and abolish that induced by CT. These effects were obtained with doses of less than 100 micrograms/kg of the products, higher doses being ineffective. The higher efficacy against CT-induced hypersecretion as compared to PGE1-induced hypersecretion suggests a direct antisecretory effect at the enterocyte level and indicates the usefulness of these products as antidiarrheal agents in nonhormonally mediated diarrhea.

Alprostadil↗

Structure-activity studies of peptide YY(22-36): N-alpha-Ac-[Phe27]PYY(22-36), a potent antisecretory peptide in rat jejunum.

Peptide YY (PYY) and its homologous peptide, neuropeptide Y (NPY), are known to exhibit potent antisecretory effects in the intestine. To determine the structural requirements to elicit antisecretory effects, we have synthesized several analogs of the PYY active site, PYY(22-36), and compared their binding affinities and antisecretory potencies in rat jejunum. These investigations revealed that the hydroxyl groups of Ser23 and Thr32, as well as the imidazole group of His26, are important for activity in the intestine. N-alpha-acetylation of PYY(22-36) increased both the binding affinity and antisecretory potency. Structure-activity studies with N-alpha-Ac-PYY(22-36) showed that substitution of His26 with parachlorophenylalanine (pCl-Phe) or Tyr36 with N-Me-Tyr reduced receptor affinity, while replacement of Tyr27 with Phe increased the activity substantially. Furthermore, acylation of the alpha-NH2 group with hydrophobic groups, myristic and naphthaleneacetic acids, substantially reduced the antisecretory potencies but not the binding affinities. Further modification of N-alpha-Ac-[Phe27]PYY(22-36) may lead to the development of more potent agonist compounds, which may provide a framework for the design of a new class of antidiarrheal drugs.

Animals↗

Management and treatment of diarrhea in Honduran children: factors associated with mothers' health care behaviors.

Data from the 1984 National Maternal-Child Health and Family Planning Survey in Honduras showed that one fifth (n = 711) of the children under five had experienced diarrhea on the day of the interview or the two days preceding the interview. The health care behaviors of the mothers of these children and the factors associated with these behaviors were the focus of this study. Only 22% of the mothers consulted medical personnel concerning the diarrhea episode; 74% treated their children with some type of medication while only 17% of the children received the recommended treatment, oral rehydration therapy. Most children were treated inappropriately, often receiving a combination of antibiotics, antidiarrheals and other drugs. Bivariate and multivariate analyses showed that the variables that most consistently predicted any and all three of the behaviors were the child's age and the severity of symptoms. Mothers of children two years and older were less likely to consult or use ORT than mothers of children 6-23 months of age. Mothers whose children's diarrhea had lasted three or more days or who were vomiting were usually twice as likely to consult, give any type of treatment, or give ORT than mothers whose children had diarrhea for fewer days or who were not vomiting.

Age Factors↗

Perception of diarrhoeal diseases among mothers and mothers-to-be: implications for health education in Saudi Arabia.

The prevalent beliefs and therapeutic preferences for diarrhoea among mothers and unmarried high school girls from an urban area in Eastern Saudi Arabia were investigated. Knowledge regarding dehydration and malnutrition as a complication of diarrhoea was far from optimum in the studied groups. It was encouraging to note that a large proportion of mothers and students were not in favor of restricting food and fluids during the illness. A long list of home remedies for diarrhoea was provided by them. Two-thirds of the students opted for Oral Rehydration Therapy as the best treatment in diarrhoea whereas mothers who were in general less educated, preferred antidiarrheal liquids and injections. Channels of communication to health educate mothers and mothers-to-be are suggested.

Adolescent↗

Aluminum intake from non-prescription drugs and sucralfate.

The use of non-prescription antacids to control hyperphosphatemia has been implicated as a primary cause of aluminum intoxications in patients with reduced renal function. Additional reports suggest that oral aluminum intake may have adverse effects on mineral metabolism of patients with normal renal function. The non-prescription drugs that contain substantial quantities of aluminum salts include some antacids, buffered aspirins, antidiarrheals, and vaginal douches. Sucralfate, an anti-ulcer drug available by prescription, is the aluminum salt of sucrose sulfate. If taken as directed, the daily aluminum intake from the antacids can be as much as 5,000 mg. When aluminum buffered aspirins are used as part of the drug therapy for rheumatoid arthritis, aluminum intake can be elevated by 700 mg/day. Although aluminum intoxications have been reported among patients with reduced renal function, existing reports are not sufficient to estimate whether the chronic elevation of aluminum intake from drugs is causing adverse health effects among other patient populations.

Aluminum↗

Role of agonist-antagonist analgesics in medicine.

The history of efforts to develop new, safer and less addicting analgesic, antidiarrheal and antitussive drugs and the impact of these efforts on the understanding of the physiology of pain perception and affect, the identification of multiple opioid receptors and the finding of new analgesics has been briefly reviewed. These important findings have major implications concerning the pathology of drug abuse, and the strategies for dealing with it. The importance of these discoveries also have major implications concerning the effectiveness of scheduling of drugs under national laws and international treaties. It is argued that the types of information necessary for scheduling of some of the newer analgesics must differ from data used in previous scheduling efforts and must consider cost-benefits consideration as they relate to public health.

Analgesics↗

Comparative effects of loperamide hydrochloride on prostaglandin E1-induced contraction in isolated fundus and ileum of guinea pigs.

The tension of isolated preparations of the fundus and the ileum of guinea pigs was measured isometrically to study the specific effect of loperamide hydrochloride on prostaglandin E1-induced contraction. Prostaglandin E1 caused concentration-dependent contraction in both the fundus and the ileum, and there was no significant difference between the fundus and the ileum. Loperamide hydrochloride inhibited prostaglandin E1-induced contraction in the fundus and the ileum. From the pD'2 value, loperamide hydrochloride caused greater inhibition of the contraction in the ileum than in the fundus. In a Ca(2+)-free solution containing 0.1 mM EGTA, prostaglandin E1-induced contraction in the ileum was almost eliminated, whereas 58% of the contraction in the fundus still remained. In Ca(2+)-free solution, loperamide hydrochloride and verapamil hydrochloride had no influence on prostaglandin E1-induced contraction, but markedly inhibited Ca(2+)-induced contraction. These results suggest that loperamide hydrochloride shows regional differences between gastrointestinal smooth muscles contracted by prostaglandin E1, and this may reflect one of the mechanisms in its antidiarrheal action through the suppression of peristalsis.

Alprostadil↗

Berberine alters the processing of Alzheimer's amyloid precursor protein to decrease Abeta secretion.

Berberine is an isoquinoline alkaloid isolated from Coptidis rhizoma, a major herb widely used in Chinese herbal medicine. Berberine's biological activity includes antidiarrheal, antimicrobial, and anti-inflammatory effects. Recent findings show that berberine prevents neuronal damage due to ischemia or oxidative stress and that it might act as a novel cholesterol-lowering compound. The accumulation of amyloid-beta peptide (Abeta) derived from amyloid precursor protein (APP) is a triggering event leading to the pathological cascade of Alzheimer's disease (AD); therefore the inhibition of Abeta production should be a rational therapeutic strategy in the prevention and treatment of AD. Here, we report that berberine reduces Abeta levels by modulating APP processing in human neuroglioma H4 cells stably expressing Swedish-type of APP at the range of berberine concentration without cellular toxicity. Our results indicate that berberine would be a promising candidate for the treatment of AD.

Amyloid beta-Peptides↗

Classification and occurrence of clinically significant drug interactions with irinotecan and oxaliplatin in patients with metastatic colorectal cancer.

BACKGROUND: Pharmacokinetic and pharmacodynamic drug interactions with cytotoxic drugs may significantly influence the efficacy and toxicity of chemotherapy. OBJECTIVE: The purpose of this study was to identify drug interactions with irinotecan and oxaliplatin reported in the literature, to assess their clinical significance, and to examine the occurrence of these interactions in patients with metastatic colorectal cancer treated with either irinotecan or oxaliplatin or both. METHODS: To obtain data on drug-drug interactions with irinotecan and oxaliplatin, a literature search of PubMed and EMBASE was conducted using the search terms irinotecan, oxaliplatin, and interactions (English-language studies only published between 1980 and August 2004). The interactions found were subsequently classified for documentation evidence and severity of clinical effect, according to a 5-level classification system of a standard reference text, by a study panel of medical oncologists and clinical pharmacists. Comedication of patients who were treated with irinotecan or oxaliplatin, or both, was then examined to determine the occurrence of clinically significant interactions. RESULTS: Ninety-eight patients (50 women, 48 men;mean age, 60 years) were included in the study. Seventeen interactions with irinotecan were found in the literature, and 11 were classified as clinically significant. Only 1 nonspecific, clinically significant interaction was identified for oxaliplatin. Irinotecan-treated patients received a mean of 8 different comedications and oxaliplatin-treated patients received a mean of 6. Apart from antiemetic and antidiarrheal drugs that were prescribed for treatment-related toxicities, only 1 patient appeared to be exposed to a possible clinically significant interaction (between irinotecan and phenytoin). CONCLUSIONS: Eleven of the 17 interactions with irinotecan that were found in the literature were classified as clinically significant versus 1 clinically significant interaction with oxaliplatin. The occurrence of these interactions in the study patients with metastatic colorectal cancer was low. For medication surveillance purposes, however, the significant interactions should be considered in clinical practice.

Adolescent↗