Drug of choice for diabetic diarrhea:

(Ref: Sleisenger and Fordtran's Gastrointestinal and Liver Disease, Volume 1; P 575)Diabetic diarrhea is seen in middle aged type 1 poorly controlled diabetic patients and is characterized by intermittent, brown, watery and voluminous stools which is occasionally accompanied by tenesmus.In these patients, GI adrenergic function is impaired in autonomic neuropathy. Therefore, any adrenergic agonist may further stimulate the intestinal absorption of fluid and electrolytes.Drugs used areAlpha 2 adrenergic agonist: Clonidine. Acts as adrenergic antagonist which acts by reversing the peripheral adrenergic resorptive abnormalities.# Because of autonomic neuropathies, these patients will not experience postural hypotension.# Moreover, clonidine doesn't alter diabetic control or renal function.Somatostatin analogue: Octreotide. Useful in refractory diabetic diarrheaCodeine, Diphenoxylate with atropine, Loperamide:Used for symptomatic treatment.Anti-diarrheal agentsDrugsMain uses ;Tryptophan hydroxylaseinhibitor: Telotristat ethylSevere diarrhea due tocarcinoid tumorsEnkephalinase inhibitor-RacecadotrilAcute diarrheaSafe in childrenOctreotide* Severe secretory diarrhea due to GI tumors* Postgastrectomy dumping syndromeCrofelemer (plant derived)HIV/AIDS diarrheaAlosetron* Diarrhea-predominant IBS in womenBile acid sequestrants:Cholestyramine, Colesevelam, ColestipiolBile salt induced diarrheaClonidineDiabetic diarrheaMOR agonists* Diphenoxylate, difenoxin, LoperamideAcute diarrheaChronic diarrheaTraveler's diarrheaAntibiotics--empiric therapy* Fluoroquinolone* Ciprofloxacin* Levofloxacin* Norfloxacin* OfloxacinAlternative antibiotics* Azithromycin* Rifaximin* Acute diarrhea* Traveler's diarrhea* Azithromycin: Preferred treatment for children with traveler's diarrhea* Rifaxamin: Preferred for diarrhea predominant IBS