GASTROINTESTINAL DRUGS

DRUGS AFFECTING GASTROINTESTINAL MOTILITY

Contraindications/ Nursing
Drug Class Drugs Indications Pharmacokinetics Adverse Effects
Cautions Considerations
LAXATIVES
Chemical bisacodyl (Dulcolax) -short-term treatment of -most of these agents -contraindicated with -GI effects (diarrhea, -administer a laxative only
Stimulants cascara (generic) constipation, treatment of are only minimally allergy to any abdominal cramping, as a temporary measure
castor oil (Neoloid) encopresis, and in absorbed and exert component of the drug, and nausea) -administer the oral form
senna (Senokot) emptying of the GI tract their therapeutic effect and in acute abdominal -CNS effects with a full glass of water
before surgeries or directly in the GI tract. disorders, including (dizziness, headache, and caution the patient not
diagnostic tests appendicitis, and weakness) to chew tablets. Encourage
diverticulitis, and -sweating, fluid intake throughout the
ulcerative colitis palpitations, flushing, day as appropriate.
-should be used with and even fainting -administer bulk laxatives
caution in heart block, with plenty of water
coronary artery disease -insert rectal suppositories
(CAD), or debilitation, high into the rectum;
and with great caution encourage patients to
during pregnancy and retain enemas or rectal
lactation solution as long as
Bulk Stimulants magnesium sulfate (Epsom -short-term treatment of -directly effective -contraindicated with -GI effects (diarrhea, possible
salts) constipation, prevention within the GI tract and allergy to any abdominal cramping, -do not administer in the
magnesium citrate (Citrate of of straining after GI are not generally component of the drug, and nausea) presence of acute
Magnesia) surgery, obstetrical absorbed systemically. and in acute abdominal -CNS effects abdominal pain, nausea, or
magnesium hydroxide (Milk delivery, MI; alternative They are rapidly disorders, including (dizziness, headache, vomiting
of Magnesia) choice for patients with acting, causing effects appendicitis, and weakness)
lactulose (Chronulac) CV disease as they pass through diverticulitis, and -sweating,
polycarbophil (FiberCon) the GI tract. ulcerative colitis palpitations, flushing,
psyllium (Metamucil) -should be used with and cramping
polyethylene glycol- caution in heart block, -obstruct esophagus
electrolyte solution CAD and debilitation, and cause severe
(GoLYTELY, MiraLAX) and with great caution problems
during pregnancy and
lactation
-polyethylene glycol-
electrolyte solution
should be used with
caution in any patient
with a history of
seizures
Lubricants docusate (Colace) -short-term treatment of -not absorbed -contraindicated with -GI effects (diarrhea,
glycerin (Sani-Supp) constipation, prophylaxis systemically and are allergy to any abdominal cramping,
mineral oil (Agoral Plain) for patients who should excreted in the feces. component of the drug, and nausea)
not strain (after surgery, and in acute abdominal -CNS effects
MI, or obstetrical delivery) disorders, including (dizziness, headache,
appendicitis, and weakness)
diverticulitis, and -sweating,
ulcerative colitis palpitations, flushing,
-should be used with and even fainting
caution in heart block,
CAD, and debilitation;
and during pregnancy
and lactation
Other Laxatives methylnaltrexone (Relistor) -treatment of opioid- -given by daily -contraindicated in -abdominal pain,
induced constipation in subcutaneous patients with known or flatulence, nausea,
patients with advanced injections. It reaches suspected mechanical dizziness, and
disease who are receiving peak levels in 1/2 hour obstruction and patients diarrhea
palliative care and are no and is eliminated at increased risk of
longer responsive to primarily unchanged in recurrent GI obstruction
traditional laxatives the urine
Gastrointestinal dexpanthenol (Ilopan) -indicated when more -metabolized in the -should not be used in -GI effects (nausea, -administer at least 15
Stimulants metoclopramide (Reglan) rapid movement of GI liver and excreted in patients with a history vomiting, diarrhea, minutes before each meal
contents is desirable feces and urine. It of allergy to any of intestinal spasm, and and at bedtime
crosses the placenta these drugs, or with any cramping) -monitor blood pressure
and enters breast milk GI obstruction or -declining blood carefully if giving the drug
perforation pressure and heart intravenously
-should be used with rate, weakness, and -monitor diabetic patients,
caution during fatigue who will have increased
pregnancy or lactation speed of transit through
the GI tract, which could
alter absorption and
glucose levels
Antidiarrheals bismuth subsalicylate (Pepto- -indicated for the relief of -absorbed from the GI -should not be given to -GI effects -administer the drug after
Bismol) symptoms of acute and tract after oral anyone with known (constipation, each unformed stool; keep
loperamide (Imodium) chronic diarrhea, administration, allergy to the drug or distention, abdominal track of the exact amount
opium derivatives (paregoric) reduction of volume of metabolized in the any of its components discomfort, nausea, given
discharge from liver, and excreted in -caution should be used vomiting, dry mouth, -monitor the response
ileostomies, and urine. It crosses the in pregnancy and and even toxic carefully; note the
prevention and treatment placenta, but it is not lactation; with any megacolon) frequency and
of traveler’s diarrhea known whether it history of GI -fatigue, weakness, characteristics of the stool.
enters breast milk obstruction; acute dizziness, and skin If no response is seen
abdominal conditions, rash within 48 hours; arrange to
or diarrhea due to -light-headedness, discontinue the drug and
poisonings; with hepatic sedation, euphoria, arrange for medical
impairment hallucinations, and evaluation
respiratory depression
GASTROINTESTINAL DRUGS
Irritable Bowel alosetron (Lotronex) -decreased perception of -oral administration -contraindicated to -frequent nausea; -take the drug with foods to
Syndrome Drugs abdominal pain and patients with history of diarrhea, increased decrease adverse effects
discomfort, decreased GI mechanical obstruction, bowel sounds, -drink plenty of fluids
motility, and increased those with chronic or constipation,
colon transit time. severe constipation, drowsiness,
lubiprostone (Amitiza) -treatment of chronic, Crohn’s disease or headache, difficulty
idiopathic constipation ulcerative colitis, or urinating, dizziness of
and for the treatment of intestinal obstruction or lightheadedness
IBS with constipation in stricture, glaucoma,
adult women CHF, myasthenia
hyoscyamine (Anaspaz) -treatment of IBS gravis, and high blood
pressure
GASTROINTESTINAL DRUGS
DRUGS AFFECTING GASTROINTESTINAL SECRETIONS
Contraindications/ Nursing
Drug Class Drugs Indications Pharmacokinetics Adverse Effects
Cautions Considerations
DRUGS USED TO TREAT GASTROESOPHAGEAL REFLUX DISEASE AND ULCER DISEASE
Histamine-2 cimetidine (Tagamet, - treatment of gastric and -metabolized by the -should not be used -GI effects (diarrhea or -administer oral drug with
Antagonists Tagamet HB) duodenal ulcer and liver and excreted in with known allergy to constipation) or before meals and at
famotidine (Pepcid, Pepcid esophageal reflux urine. It crosses the any drugs of this class -CNS effects bedtime (exact timing
AC) disease, and to prevent placenta and enters -caution should be used (dizziness, headache, varies with product)
nizatidine (Axid) stress ulcers breast milk during pregnancy or somnolence, -monitor the patient
ranitidine (Zantac) lactation, and with confusion, or even continually if giving IV
hepatic or renal hallucinations) doses
dysfunction -cardiac arrhythmias -provide comfort, including
-care should also be and hypotension analgesics, ready access
taken if prolonged or -gynecomastia and to bathroom facilities, and
continual use of these impotence assistance with ambulation
drugs -periodically reorient the
patient and institute safety
measures if CNS effects
occur
-arrange for regular follow-
up
-arrange for decreased
dose in cases of hepatic or
renal dysfunction
Antacids aluminum salts (AlternaGEL) -recommended for the -metabolized in the - contraindicated in the -acid rebound -administer the drug apart
calcium salts (Oystercal, symptomatic relief of liver and excreted in presence of any known - nausea, vomiting, from any other oral
Tums) upset stomach associated urine and feces. It allergy to antacid neuromuscular medications approximately
magaldrate (Losopan, with hyperacidity, as well crosses the placenta products or any changes, headache, 1 hour before or 2 hours
Riopan) as the hyperacidity and enter breast milk component of the drug irritability, muscle after
magnesium salts (Milk of associated with peptic -caution should be used twitching, and even -have the patient chew
Magnesia, others) ulcer, gastritis, peptic in the following coma) tablets thoroughly and
sodium bicarbonate (Bell- esophagitis, gastric instances: any -hypercalcemia and follow with water
ans) hyperacidity, and hiatal condition that can be milk-alkali syndrome -obtain specimens for
hernia exacerbated by -constipation or periodic monitoring of
electrolyte or acid–base diarrhea, serum
imbalance; any hypophosphatemia, -assess the patient for any
electrolyte imbalance; fluid retention and signs of acid–base or
GI obstruction; renal heart failure electrolyte imbalance
dysfunction; and -monitor the patient for
pregnancy and lactation diarrhea or constipation;
nutritional status if diarrhea
is severe or constipation
leads to decreased food
intake
Proton Pump dexlansoprazole (Kapidex) -recommended for the -acid labile and are - contraindicated in the -CNS effects -administer drug before
Inhibitors esomeprazole (Nexium) short-term treatment of rapidly absorbed from presence of known (dizziness and meals to ensure that the
lansoprazole (Prevacid) active duodenal ulcers, the GI tract, reaching allergy to either the headache are patient does not open,
omeprazole (Prilosec) GERD, erosive peak levels in 3 to 5 drug or the drug commonly seen; chew, or crush capsules;
pantoprazole (Protonix) esophagitis, and benign hours. They undergo components asthenia (loss of they should be swallowed
rabeprazole (Aciphex) active gastric ulcer; for extensive metabolism -caution should be used strength), vertigo, whole
the long-term treatment of in the liver and are in pregnant or lactating insomnia, apathy, and -monitor the patient’s
pathological excreted in urine. women dream abnormalities) nutritional status; use of
hypersecretory There are no adequate -the safety and efficacy -GI effects (diarrhea, small frequent meals may
conditions; as studies about whether of these drugs have not abdominal pain, be helpful
maintenance therapy for these drugs cross the been established for nausea, vomiting, dry -arrange for medical follow-
healing of erosive placenta or enter patients younger than mouth, and tongue up if symptoms are not
esophagitis and ulcers; breast milk. 18 years of age, except atrophy) resolved after 4 to 8 weeks
and in combination with for lansoprazole, which -upper respiratory of therapy
amoxicillin and is the proton pump tract symptoms
clarithromycin for the inhibitor of choice if one (cough, stuffy nose,
treatment of H. pylori is needed for a child hoarseness, and
infection epistaxis)
-rash, alopecia,
pruritus, dry skin, back
pain, and fever
-increase in bone loss
and decreased
calcium levels,
decreased
magnesium levels,
and increased
incidence of
Clostridium difficile
diarrhea and
pneumonia
GI Protectant sucralfate (Carafate) -inhibits pepsin activity in -rapidly absorbed after -should not be given to -GI effects -administer the drug on an
gastric juices, preventing oral administration, any person with known (constipation, empty stomach, 1 hour
further breakdown of metabolized in the allergy to the drug or diarrhea, nausea, before or 2 hours after
proteins in the stomach, liver, and excreted in any of its components; indigestion, gastric meals and at bedtime
including the protein wall feces. It crosses the and to individuals with discomfort, and dry -administer antacids or
of the stomach; and placenta and may renal failure or mouth) antibiotics, if ordered,
promotes ulcer healing enter breast milk. undergoing dialysis -dizziness, sleepiness, between doses of
-caution should be used vertigo, skin rash, and sucralfate, not within 30
in patients who are back pain minutes of a sucralfate
pregnant or lactating dose
GASTROINTESTINAL DRUGS
-provide frequent mouth
care, including sugarless
lozenges to suck
-ensure ready access to
bathroom facilities, institute
bowel training as needed,
and provide small, frequent
meals
Prostaglandin misoprostol (Cytotec) -primarily used to prevent -given orally. It is - contraindicated with -GI effects (nausea, -administer to patients at
NSAID-induced gastric rapidly absorbed from allergy to any part of diarrhea, abdominal high risk for nonsteroidal
ulcers in patients who are the GI tract, the drug; during pain, flatulence, anti-inflammatory drug
at high risk for metabolized in the pregnancy vomiting, dyspepsia, (NSAID)-induced ulcers
complications from a liver, and excreted in -caution should be used and constipation) during the full course of
gastric ulcer (e.g., elderly urine. Misoprostol during lactation, and -GU effects NSAID therapy
or debilitated patients, crosses the placenta with hepatic or renal (miscarriages, -administer four times a
patients with a past and enters breast milk. impairment excessive bleeding, day, with meals and at
history of ulcer). spotting, cramping, bedtime
hypermenorrhea, -arrange for a serum
dysmenorrhea, and pregnancy test within 2
other menstrual weeks before beginning
disorder) treatment and begin
therapy on the second or
third day of the menstrual
period
-provide the patient with
both written and oral
information regarding the
associated risks of
pregnancy; advise the use
of barrier contraceptives
during therapy
-evaluate nutritional status
if GI effects are severe,
such as small, frequent
meals, and increased fluid
intake if appropriate
-explain the risk of
menstrual disorders and
pain, miscarriage, and
excessive bleeding
DRUGS USED TO TREAT DIGESTIVE ENZYME DYSFUNCTION
Digestive Enzymes saliva substitute (MouthKote, -helps in conditions that -saliva substitute is - contraindicated in the -abnormal electrolyte -have the patient swish a
Salivart) result in dry mouth— available as a solution, presence of known absorption, such as saliva substitute around
pancrelipase (Creon, stroke, radiation therapy, in lozenge form, and allergy to parabens or increased levels of the mouth as needed for
Pancrease) chemotherapy, and other on swab sticks for oral any component of the magnesium, sodium, dry mouth and throat;
illnesses. The pancreatic administration in the drug and potassium. monito swallowing
enzymes are replacement mouth. It is not -should be used -GI effects (GI -administer pancreatic
enzymes that help the generally absorbed cautiously in patients irritation, nausea, enzymes with meals and
digestion and absorption systemically. It works with heart failure, abdominal cramps, snacks so that enzyme is
of fats, proteins, and when applied to the hypertension, or renal and diarrhea) available when it is
carbohydrates mouth. failure; and during needed. Avoid spilling
-pancrelipase, which is pregnancy and lactation powder on the skin. Do not
available in capsules, -pancreatic enzymes crush the capsule or allow
delayed-release should not be used with the patient to chew it; it
capsules, powder, and known allergy to the must be swallowed
tablet form, is thought product or to pork
to be processed product
through normal
metabolic systems in
the body. Little is
known about its
pharmacokinetics
GASTROINTESTINAL DRUGS
ANTIEMETIC AGENTS
Contraindications/ Nursing
Drug Class Drugs Indications Pharmacokinetics Adverse Effects
Cautions Considerations
Phenothiazines prochlorperazine (generic) -treatment of nausea and -rapid onset of action -should not be used in -CNS effects -assure that route of
promethazine (Phenergan) vomiting, including that of 5 to 20 minutes and patients with coma or (drowsiness, administration is
chlorpromazine (Thorazine) specifically associated a duration of action of severe central nervous dizziness, weakness, appropriate for each
perphenazine (Trilafon) with anesthesia, severe 3 to 12 hours, system (CNS) tremor, and patient; if used to prevent
vomiting, and intractable depending on route of depression or in those headache) motion sickness, should be
hiccoughs, which occur administration. They who have experienced -hypotension, given 30 minutes before
with repetitive stimulation are metabolized in the brain damage or injury; hypertension, and activity that involves
of the diaphragm and lead liver and excreted in severe hypotension or cardiac arrhythmias motion; some oral tablets
to persistent diaphragm the urine. They are hypertension and -dry mouth, nasal can be placed in the mouth
spasm known to cross the severe liver dysfunction congestion, anorexia, and allowed to dissolve
placenta and enter -caution should be used pallor, sweating, and slowly; rectal suppositories
breast milk. in individuals with renal urinary retention should be inserted high
-available as tablets or dysfunction, moderate -menstrual disorders, into the rectum; IV
as syrup for oral liver impairment, active galactorrhea, and infusions should be run
administration, as peptic ulcer, or during gynecomastia slowly, monitoring the
rectal suppositories, pregnancy and lactation -photosensitivity patient for CNS
and as solution for -urine may be tinged depression.
intramuscular (IM) or pink to red-brown -assess the patient
intravenous (IV) use carefully for any potential
Nonphenothiazine metoclopramide (Reglan) -prevention of nausea and -metabolized in the -should not be used in -GI effects (nausea, drug– drug interactions if
vomiting associated with liver and excreted in patients with a history vomiting, diarrhea, giving antiemetics in
emetogenic cancer feces and urine. It of allergy to any of intestinal spasm, and combination with other
chemotherapy, prevention crosses the placenta these drugs, or with any cramping) drugs
of postoperative nausea and enters breast milk GI obstruction or -declining blood
and vomiting perforation pressure and heart
-should be used with rate, weakness, and
caution during fatigue
pregnancy or lactation
Anticholinergics/ buclizine (Bucladin) -treatment of nausea and -given orally, reaching -contraindicated with -dry mouth, nasal
Antihistamines cyclizine (Marezine) vomiting associated with peak levels in 1 to 2 known allergy to any congestion, anorexia,
meclizine (Antivert) motion sickness hours and lasting 6 to component of the drug, pallor, sweating, and
24 hours, depending and during pregnancy urinary retention
on the drug being and lactation -drowsiness,
used. They are -caution should be used confusion,
metabolized in the liver in any situation in which hypotension, and
and are excreted in the anticholinergic respiratory depression
urine and feces. They effects could be a
are known to cross the problem, such as
placenta and enter narrow-angle
breast milk glaucoma, benign
prostatic hyperplasia,
peptic ulcer disease,
bronchial asthma, and
hypotension
5-HT3Receptor dolasetron (Anzemet) -treatment of nausea and -rapidly absorbed, -contraindicated with -CNS effects
Blockers granisetron (Kytril) vomiting associated with reaching peak levels known allergy to any (headache, dizziness,
ondansetron (Zofran) emetogenic within 1 hour. They are component of the drug and myalgia)
palonosetron (Aloxi) chemotherapy metabolized in the liver -caution should be used -pain at the injection
and excreted in urine during pregnancy and site, rash,
lactation constipation,
hypotension, and
urinary retention
Substance P/ aprepitant (Emend) -use in treating the -metabolized in the -should not be used -GI effects (diarrhea,
Neurokinin 1 nausea and vomiting liver and excreted in during pregnancy and constipation, and
Receptor associated with highly urine and feces. This lactation, or with known gastritis, nausea;
Antagonist emetogenic antineoplastic drug is known to cross allergy to any anorexia; headache;
chemotherapy, including the placenta and to component of the drug and fatigue)
cisplatin therapy. It is enter breast milk.
given orally, in
combination with
dexamethasone.
Miscellaneous dronabinol (Marinol) - use in managing the -readily absorbed and -caution should be used -changes in mood,
Agents nabilone (Cesamet) nausea and vomiting metabolized in the during pregnancy and delusions, fast or
associated with cancer liver, with excretion lactation pounding heartbeat,
chemotherapy in cases through the bile and in loss of memory,
that have not responded urine. mental depression,
to other treatment nervousness or
anxiety
-agitation, body aches,
goosebumps
hydroxyzine (Vistaril) -used for nausea and -rapidly absorbed, -caution should be used -chest pain, irregular
vomiting before or after metabolized in the during pregnancy and or slow heart rate,
obstetrical delivery or liver, and excreted in lactation puffiness, trouble
surgery urine breathing, hives, rash
trimethobenzamide (Tigan) -treatment of nausea and -rapidly absorbed, -caution should be used -drowsiness,
vomiting (not sedating) metabolized in the during pregnancy and dizziness, headache,
liver, and excreted in lactation depression, diarrhea
urine. It crosses the
placenta and enters
breast milk