Diarrhea Secondary to Medications

Aka: Diarrhea Secondary to Medications, Drug-Induced Diarrhea, Medication-Induced Diarrhea, Medication Causes of Diarrhea

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II. Causes: Medication Class

  1. Antibiotic Associated Diarrhea
    1. See Clostridium difficile
    2. Macrolides (e.g. Erythromycin)
    3. Aminoglycosides
    4. Amoxicillan-Clavulanate (Augmentin)
  2. Chemotherapeutic agents
  3. Antiinflammatory medications
    1. NSAIDS
    2. Colchicine
    3. Ticlopidine
  4. Antiarrhythmics
    1. Quinidine
    2. Digitalis (Digoxin)
  5. Antihypertensives
    1. Beta Blockers
    2. ACE Inhibitors
    3. Olmesartan (Benicar)
      1. May cause a sprue-like Enteropathy not seen with other Angiotensin Receptor Blockers
  6. Endocrine agents
    1. Acarbose (Precose)
    2. Orlistat (Xenical)
    3. Metformin (Glucophage)
    4. Thyroid Replacement
  7. Gastrointestinal Agents
    1. Magnesium Supplements
    2. Calcium containing Antacids
    3. Stimulant Laxatives (e.g. Bisacodyl, senna)
    4. H2 Receptor Antagonists (e.g. Ranitidine)
    5. Proton Pump Inhibitors (e.g. Omeprazole)
    6. Metoclopramide (Reglan)
  8. Miscellaneous agents
    1. Misoprostol
    2. Theophylline
    3. Calcitonin
    4. Lithium
    5. Selective Serotonin Reuptake Inhibitors (e.g. Sertraline)

III. Causes: Osmotic Diarrhea

  1. Magnesium containing preparations (Antacids, Laxatives)
  2. Citrates
  3. Phosphates
  4. Sulfates
  5. Sugar Alcohols
    1. Mannitol
    2. Sorbitol
    3. Xylitol

IV. Causes: Secretory Diarrhea

  1. Antiarrhythmics (Quinidine, Digoxin)
  2. Amoxicillan-Clavulanate (Augmentin)
  3. Chemotherapeutic agents
  4. Metformin (Glucophage)
  5. Calcitonin
  6. Colchicine
  7. NSAIDs
  8. Misoprostol

V. Causes: Increased Motility

  1. Macrolides (e.g. Erythromycin)
  2. Metoclopramide (Reglan)
  3. Stimulant Laxatives (e.g. Bisacodyl, senna)

VI. Causes: Malabsorption

  1. Acarbose (Precose)
  2. Aminoglycosides
  3. Orlistat (Xenical)
  4. Thyroid Replacement

VII. References

  1. Schiller in Feldman (2002) Sleisenger GI, p. 136
  2. Burgers (2020) Am Fam Physician 101(8): 472-80 [PubMed]

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