Potential intervention On recommendation of an agent to treat diarrhea

Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:

  • Synthroid 100 mcg daily

  • Nifedipine 30 mg daily
  • Prednisone 10 mg daily

This week’s patient has some rather non-specific GI complaints.  One potential intervention is the prescription or recommendation of an agent to treat diarrhea.  While many anti-diarrheal agents are available over-the-counter, it does not mean that they can be used indiscriminately.  If anti-motility agents are used in patients with bloody diarrhea, complications may result.  Additionally, in 2016, the FDA issued an alert regarding cardiac arrest and syncope associated with the commonly used anti-motility agent, loperamide.  Interestingly, these events were most commonly noted in patients who were abusing loperamide, sometimes to self-treat for opioid withdrawal (FDA, 2016).  So, while loperamide is an effective antidiarrheal agent, it must be taken according to directions.

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Reference:

FDA. (2016).  FDA warns about serious heart problems with high doses of the antidiarrheal medicine loperamide (Imodium), including from abuse and misuse.  Retrieved from https://www.fda.gov/downloads/Drugs/DrugSafety/UCM505108.pdf

The patient in this case has a history of drug abuse and possible hepatitis C.  The treatment of hepatitis C has advanced significantly over the past decade and it is now considered a curable condition for many patients.  With that said, there are many considerations and barriers to therapy.

1.  A definitive diagnosis with genotyping must be completed.  The type of therapy will vary based on the viral genotype that is identified.

2.  The level of liver fibrosis, compensation, and other patient specific factors must be assessed.

3.  Many hepatitis C therapies cost $60,000-115,000 per course of therapy.  While medical assistance programs do exist, this cost can still be a significant burden that requires discussion and careful planning.

The reference below contains additional details explaining some of the costs and considerations with newer hepatitis C therapies.

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