131 lines
38 KiB
Text
131 lines
38 KiB
Text
<!DOCTYPE html>
|
|
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" class="no-js no-jr">
|
|
<head>
|
|
<!-- For pinger, set start time and add meta elements. -->
|
|
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
|
|
|
<!-- Logger begin -->
|
|
<meta name="ncbi_db" content="books">
|
|
<meta name="ncbi_pdid" content="book-part">
|
|
<meta name="ncbi_acc" content="NBK548487">
|
|
<meta name="ncbi_domain" content="livertox">
|
|
<meta name="ncbi_report" content="reader">
|
|
<meta name="ncbi_type" content="fulltext">
|
|
<meta name="ncbi_objectid" content="">
|
|
<meta name="ncbi_pcid" content="/NBK548487/?report=reader">
|
|
<meta name="ncbi_pagename" content="Gastrointestinal Agents - LiverTox - NCBI Bookshelf">
|
|
<meta name="ncbi_bookparttype" content="chapter">
|
|
<meta name="ncbi_app" content="bookshelf">
|
|
<!-- Logger end -->
|
|
|
|
<!--component id="Page" label="meta"/-->
|
|
<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Gastrointestinal Agents - LiverTox - NCBI Bookshelf</title>
|
|
<meta charset="utf-8">
|
|
<meta name="apple-mobile-web-app-capable" content="no">
|
|
<meta name="viewport" content="initial-scale=1,minimum-scale=1,maximum-scale=1,user-scalable=no">
|
|
<meta name="jr-col-layout" content="auto">
|
|
<meta name="jr-prev-unit" content="/books/n/livertox/GarciniaCambogia/?report=reader">
|
|
<meta name="jr-next-unit" content="/books/n/livertox/GaucherDiseaseAgents/?report=reader">
|
|
<meta name="bk-toc-url" content="/books/n/livertox/?report=toc">
|
|
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE">
|
|
<meta name="citation_inbook_title" content="LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]">
|
|
<meta name="citation_title" content="Gastrointestinal Agents">
|
|
<meta name="citation_publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases">
|
|
<meta name="citation_date" content="2019/04/25">
|
|
<meta name="citation_pmid" content="31643806">
|
|
<meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK548487/">
|
|
<link rel="schema.DC" href="http://purl.org/DC/elements/1.0/">
|
|
<meta name="DC.Title" content="Gastrointestinal Agents">
|
|
<meta name="DC.Type" content="Text">
|
|
<meta name="DC.Publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases">
|
|
<meta name="DC.Date" content="2019/04/25">
|
|
<meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK548487/">
|
|
<meta name="description" content="Medications for gastrointestinal diseases and symptoms include prescription and nonprescription drugs, conventional and unconventional agents, simple small molecules, complex macromolecules and large recombinant proteins. These medications are can be classified based upon their use: drugs for nausea and vomiting (antiemetics), prokinetic agents, laxatives, antidiarrheal agents, drugs for acid peptic disease, drugs for irritable bowel syndrome, inflammatory bowel disease and, of course, miscellaneous. Agents used for gastrointestinal disease rarely cause liver injury. One reason for this is that they are often locally active and result in little systemic exposure. The immunomodulatory agents used to treat inflammatory bowel disease are an exception, being given systemically, often intravenously and capable of causing liver injury, although not very frequently.">
|
|
<meta name="og:title" content="Gastrointestinal Agents">
|
|
<meta name="og:type" content="book">
|
|
<meta name="og:description" content="Medications for gastrointestinal diseases and symptoms include prescription and nonprescription drugs, conventional and unconventional agents, simple small molecules, complex macromolecules and large recombinant proteins. These medications are can be classified based upon their use: drugs for nausea and vomiting (antiemetics), prokinetic agents, laxatives, antidiarrheal agents, drugs for acid peptic disease, drugs for irritable bowel syndrome, inflammatory bowel disease and, of course, miscellaneous. Agents used for gastrointestinal disease rarely cause liver injury. One reason for this is that they are often locally active and result in little systemic exposure. The immunomodulatory agents used to treat inflammatory bowel disease are an exception, being given systemically, often intravenously and capable of causing liver injury, although not very frequently.">
|
|
<meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK548487/">
|
|
<meta name="og:site_name" content="NCBI Bookshelf">
|
|
<meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png">
|
|
<meta name="twitter:card" content="summary">
|
|
<meta name="twitter:site" content="@ncbibooks">
|
|
<meta name="bk-non-canon-loc" content="/books/n/livertox/GastrointestinalAgen/?report=reader">
|
|
<link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK548487/">
|
|
<link href="https://fonts.googleapis.com/css?family=Archivo+Narrow:400,700,400italic,700italic&subset=latin" rel="stylesheet" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/libs.min.css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/jr.min.css">
|
|
<meta name="format-detection" content="telephone=no">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css//books_print.min.css" type="text/css" media="print">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_reader.min.css" type="text/css">
|
|
<style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style>
|
|
|
|
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico">
|
|
<meta name="ncbi_phid" content="CE8B9FF67D800F610000000000680059.m_5">
|
|
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3849091.css"></head>
|
|
<body>
|
|
<!-- Book content! -->
|
|
|
|
|
|
<div id="jr" data-jr-path="/corehtml/pmc/jatsreader/ptpmc_3.22/"><div class="jr-unsupported"><table class="modal"><tr><td><span class="attn inline-block"></span><br />Your browser does not support the NLM PubReader view.<br />Go to <a href="/pmc/about/pr-browsers/">this page</a> to see a list of supported browsers<br />or return to the <br /><a href="/books/NBK548487/?report=classic">regular view</a>.</td></tr></table></div><div id="jr-ui" class="hidden"><nav id="jr-head"><div class="flexh tb"><div id="jr-tb1"><a id="jr-links-sw" class="hidden" title="Links"><svg xmlns="http://www.w3.org/2000/svg" version="1.1" x="0px" y="0px" viewBox="0 0 70.6 85.3" style="enable-background:new 0 0 70.6 85.3;vertical-align:middle" xml:space="preserve" width="24" height="24">
|
|
<style type="text/css">.st0{fill:#939598;}</style>
|
|
<g>
|
|
<path class="st0" d="M36,0C12.8,2.2-22.4,14.6,19.6,32.5C40.7,41.4-30.6,14,35.9,9.8"></path>
|
|
<path class="st0" d="M34.5,85.3c23.2-2.2,58.4-14.6,16.4-32.5c-21.1-8.9,50.2,18.5-16.3,22.7"></path>
|
|
<path class="st0" d="M34.7,37.1c66.5-4.2-4.8-31.6,16.3-22.7c42.1,17.9,6.9,30.3-16.4,32.5h1.7c-66.2,4.4,4.8,31.6-16.3,22.7 c-42.1-17.9-6.9-30.3,16.4-32.5"></path>
|
|
</g>
|
|
</svg> Books</a></div><div class="jr-rhead f1 flexh"><div class="head"><a href="/books/n/livertox/GarciniaCambogia/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="body"><div class="t">Gastrointestinal Agents</div><div class="j">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]</div></div><div class="tail"><a href="/books/n/livertox/GaucherDiseaseAgents/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></div><div id="jr-tb2"><a id="jr-bkhelp-sw" class="btn wsprkl hidden" title="Help with NLM PubReader">?</a><a id="jr-help-sw" class="btn wsprkl hidden" title="Settings and typography in NLM PubReader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" preserveAspectRatio="none"><path d="M462,283.742v-55.485l-29.981-10.662c-11.431-4.065-20.628-12.794-25.274-24.001 c-0.002-0.004-0.004-0.009-0.006-0.013c-4.659-11.235-4.333-23.918,0.889-34.903l13.653-28.724l-39.234-39.234l-28.72,13.652 c-10.979,5.219-23.68,5.546-34.908,0.889c-0.005-0.002-0.01-0.003-0.014-0.005c-11.215-4.65-19.933-13.834-24-25.273L283.741,50 h-55.484l-10.662,29.981c-4.065,11.431-12.794,20.627-24.001,25.274c-0.005,0.002-0.009,0.004-0.014,0.005 c-11.235,4.66-23.919,4.333-34.905-0.889l-28.723-13.653l-39.234,39.234l13.653,28.721c5.219,10.979,5.545,23.681,0.889,34.91 c-0.002,0.004-0.004,0.009-0.006,0.013c-4.649,11.214-13.834,19.931-25.271,23.998L50,228.257v55.485l29.98,10.661 c11.431,4.065,20.627,12.794,25.274,24c0.002,0.005,0.003,0.01,0.005,0.014c4.66,11.236,4.334,23.921-0.888,34.906l-13.654,28.723 l39.234,39.234l28.721-13.652c10.979-5.219,23.681-5.546,34.909-0.889c0.005,0.002,0.01,0.004,0.014,0.006 c11.214,4.649,19.93,13.833,23.998,25.271L228.257,462h55.484l10.595-29.79c4.103-11.538,12.908-20.824,24.216-25.525 c0.005-0.002,0.009-0.004,0.014-0.006c11.127-4.628,23.694-4.311,34.578,0.863l28.902,13.738l39.234-39.234l-13.66-28.737 c-5.214-10.969-5.539-23.659-0.886-34.877c0.002-0.005,0.004-0.009,0.006-0.014c4.654-11.225,13.848-19.949,25.297-24.021 L462,283.742z M256,331.546c-41.724,0-75.548-33.823-75.548-75.546s33.824-75.547,75.548-75.547 c41.723,0,75.546,33.824,75.546,75.547S297.723,331.546,256,331.546z"></path></svg></a><a id="jr-fip-sw" class="btn wsprkl hidden" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-rtoc-sw" class="btn wsprkl hidden" title="Table of Contents"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,20h10v8H20V20zM36,20h44v8H36V20zM20,37.33h10v8H20V37.33zM36,37.33h44v8H36V37.33zM20,54.66h10v8H20V54.66zM36,54.66h44v8H36V54.66zM20,72h10v8 H20V72zM36,72h44v8H36V72z"></path></svg></a></div></div></nav><nav id="jr-dash" class="noselect"><nav id="jr-dash" class="noselect"><div id="jr-pi" class="hidden"><a id="jr-pi-prev" class="hidden" title="Previous page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a><div class="pginfo">Page <i class="jr-pg-pn">0</i> of <i class="jr-pg-lp">0</i></div><a id="jr-pi-next" class="hidden" title="Next page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div><div id="jr-is-tb"><a id="jr-is-sw" class="btn wsprkl hidden" title="Switch between Figures/Tables strip and Progress bar"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><rect x="10" y="40" width="20" height="20"></rect><rect x="40" y="40" width="20" height="20"></rect><rect x="70" y="40" width="20" height="20"></rect></svg></a></div><nav id="jr-istrip" class="istrip hidden"><a id="jr-is-prev" href="#" class="hidden" title="Previous"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M80,40 60,65 80,90 70,90 50,65 70,40z M50,40 30,65 50,90 40,90 20,65 40,40z"></path><text x="35" y="25" textLength="60" style="font-size:25px">Prev</text></svg></a><a id="jr-is-next" href="#" class="hidden" title="Next"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,40 40,65 20,90 30,90 50,65 30,40z M50,40 70,65 50,90 60,90 80,65 60,40z"></path><text x="15" y="25" textLength="60" style="font-size:25px">Next</text></svg></a></nav><nav id="jr-progress"></nav></nav></nav><aside id="jr-links-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">NCBI Bookshelf</div></div><div class="cnt lol f1"><a href="/books/">Home</a><a href="/books/browse/">Browse All Titles</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://www.facebook.com/sharer/sharer.php?u=https://www.ncbi.nlm.nih.gov/books/NBK548487/"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24" preserveAspectRatio="none"><g><path d="M 17.996,32L 12,32 L 12,16 l-4,0 l0-5.514 l 4-0.002l-0.006-3.248C 11.993,2.737, 13.213,0, 18.512,0l 4.412,0 l0,5.515 l-2.757,0 c-2.063,0-2.163,0.77-2.163,2.209l-0.008,2.76l 4.959,0 l-0.585,5.514L 18,16L 17.996,32z"></path></g></svg> Share on Facebook</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://twitter.com/intent/tweet?url=https://www.ncbi.nlm.nih.gov/books/NBK548487/&text=Gastrointestinal%20Agents"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24"><g><path d="M 32,6.076c-1.177,0.522-2.443,0.875-3.771,1.034c 1.355-0.813, 2.396-2.099, 2.887-3.632 c-1.269,0.752-2.674,1.299-4.169,1.593c-1.198-1.276-2.904-2.073-4.792-2.073c-3.626,0-6.565,2.939-6.565,6.565 c0,0.515, 0.058,1.016, 0.17,1.496c-5.456-0.274-10.294-2.888-13.532-6.86c-0.565,0.97-0.889,2.097-0.889,3.301 c0,2.278, 1.159,4.287, 2.921,5.465c-1.076-0.034-2.088-0.329-2.974-0.821c-0.001,0.027-0.001,0.055-0.001,0.083 c0,3.181, 2.263,5.834, 5.266,6.438c-0.551,0.15-1.131,0.23-1.73,0.23c-0.423,0-0.834-0.041-1.235-0.118 c 0.836,2.608, 3.26,4.506, 6.133,4.559c-2.247,1.761-5.078,2.81-8.154,2.81c-0.53,0-1.052-0.031-1.566-0.092 c 2.905,1.863, 6.356,2.95, 10.064,2.95c 12.076,0, 18.679-10.004, 18.679-18.68c0-0.285-0.006-0.568-0.019-0.849 C 30.007,8.548, 31.12,7.392, 32,6.076z"></path></g></svg> Share on Twitter</a></div></aside><aside id="jr-rtoc-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Table of Content</div></div><div class="cnt lol f1"><a href="/books/n/livertox/?report=reader">Title Information</a><a href="/books/n/livertox/toc/?report=reader">Table of Contents Page</a></div></aside><aside id="jr-help-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Settings</div></div><div class="cnt f1"><div id="jr-typo-p" class="typo"><div><a class="sf btn wsprkl">A-</a><a class="lf btn wsprkl">A+</a></div><div><a class="bcol-auto btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 200 100" preserveAspectRatio="none"><text x="10" y="70" style="font-size:60px;font-family: Trebuchet MS, ArialMT, Arial, sans-serif" textLength="180">AUTO</text></svg></a><a class="bcol-1 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M15,25 85,25zM15,40 85,40zM15,55 85,55zM15,70 85,70z"></path></svg></a><a class="bcol-2 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M5,25 45,25z M55,25 95,25zM5,40 45,40z M55,40 95,40zM5,55 45,55z M55,55 95,55zM5,70 45,70z M55,70 95,70z"></path></svg></a></div></div><div class="lol"><a class="" href="/books/NBK548487/?report=classic">Switch to classic view</a><a href="/books/NBK548487/pdf/Bookshelf_NBK548487.pdf">PDF (342K)</a><a href="/books/NBK548487/?report=printable">Print View</a></div></div></aside><aside id="jr-bkhelp-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Help</div></div><div class="cnt f1 lol"><a id="jr-helpobj-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/help.xml" href="">Help</a><a href="mailto:info@ncbi.nlm.nih.gov?subject=PubReader%20feedback%20%2F%20NBK548487%20%2F%20sid%3ACE8B5AF87C7FFCB1_0191SID%20%2F%20phid%3ACE8B9FF67D800F610000000000680059.4">Send us feedback</a><a id="jr-about-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/about.xml" href="">About PubReader</a></div></aside><aside id="jr-objectbox" class="thidden hidden"><div class="jr-objectbox-close wsprkl">✘</div><div class="jr-objectbox-inner cnt"><div class="jr-objectbox-drawer"></div></div></aside><nav id="jr-pm-left" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Previous Page</text></svg></nav><nav id="jr-pm-right" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Next Page</text></svg></nav><nav id="jr-fip" class="hidden"><nav id="jr-fip-term-p"><input type="search" placeholder="search this page" id="jr-fip-term" autocorrect="off" autocomplete="off" /><a id="jr-fip-mg" class="wsprkl btn" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK548487_"><span class="title" itemprop="name">Gastrointestinal Agents</span></h1><p class="fm-aai"><a href="#_NBK548487_pubdet_">Publication Details</a></p></div></div><div class="body-content whole_rhythm" itemprop="text"><div id="GastrointestinalAgen.OVERVIEW"><h2 id="_GastrointestinalAgen_OVERVIEW_">OVERVIEW</h2><div id="GastrointestinalAgen.Introduction"><h3>Introduction</h3><p>Medications for gastrointestinal diseases and symptoms include prescription and nonprescription drugs, conventional and unconventional agents, simple small molecules, complex macromolecules and large recombinant proteins. These medications are can be classified based upon their use: drugs for nausea and vomiting (antiemetics), prokinetic agents, laxatives, antidiarrheal agents, drugs for acid peptic disease, drugs for irritable bowel syndrome, inflammatory bowel disease and, of course, miscellaneous. Agents used for gastrointestinal disease rarely cause liver injury. One reason for this is that they are often locally active and result in little systemic exposure. The immunomodulatory agents used to treat inflammatory bowel disease are an exception, being given systemically, often intravenously and capable of causing liver injury, although not very frequently.</p><p>Antidiarrheal agents include bulk forming agents, hydroscopic agents, bile acid resins, bismuth, inhibitors of intestinal motility, non-absorbed antibiotics and hormones. Bulk forming agents include methylcellulose; hydroscopic agents include pectin and kaolin; bile acid resins are cholestyramine, colestipol and colesevalam; inhibitors of intestinal motility include opioids such as diphenoxylate and loperamide. Antibiotics include rifamycin and rifaximin which are non-absorbed and are used for travelers' diarrhea. Hormones with antidiarrheal activity include octretide and somatostatin. Most antidiarrheal agents are active locally in the small intestine and colon and are largely not absorbed. Some, however, have been implicated in rare causes of liver injury (senna, cascara, cholestyramine). Telotristat is a relatively new agent that inhibits the synthesis of serotonin and is used specifically for the diarrhea of carcinoid syndrome. Agents discussed in LiverTox include the following, which are linked to the specific drug record:</p><ul><li class="half_rhythm"><div>Bismuth</div></li><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/Cholestyramine/?report=reader">Cholestyramine</a>
|
|
</div></li><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/Colesevelam/?report=reader">Colesevelam</a>
|
|
</div></li><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/Colestipol/?report=reader">Colestipol</a>
|
|
</div></li><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/Crofelemer/?report=reader">Crofelemer</a>
|
|
</div></li><li class="half_rhythm"><div>Difenoxin</div></li><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/Diphenoxylate/?report=reader">Diphenoxylate</a>
|
|
</div></li><li class="half_rhythm"><div>Kaolin</div></li><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/Loperamide/?report=reader">Loperamide</a>
|
|
</div></li><li class="half_rhythm"><div>Methylcellulose</div></li><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/Octreotide/?report=reader">Octreotide</a>
|
|
</div></li><li class="half_rhythm"><div>Pectin</div></li><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/Rifamycin/?report=reader">Rifamycin</a>
|
|
</div></li><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/Rifaximin/?report=reader">Rifaximin</a>
|
|
</div></li><li class="half_rhythm"><div>Somatostatin</div></li><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/Telotristat/?report=reader">Telotristat</a>
|
|
</div></li></ul><p>Antiemetics are a diverse group of medications that act at different points in the pathways that regulate nausea and vomiting. These include antihistamines, anticholinergic agents, phenothiazines, serotonin type 3 receptor blockers, centrally acting benzamides, cannabinoid receptor agonists, substance P antagonists and miscellaneous. Agents discussed in LiverTox include the following, which have links to the specific drug record:</p><ul><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/Anticholinergics/?report=reader">Anticholinergic Agents</a>
|
|
</div><ul><li class="half_rhythm"><div><a href="/books/n/livertox/Hyoscyamine/?report=reader">Hyoscyamine</a>, <a href="/books/n/livertox/ScopolamineMethscop/?report=reader">Methscopolamine</a>, <a href="/books/n/livertox/ScopolamineMethscop/?report=reader">Scopolamine</a></div></li></ul></li><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/Antihistamines/?report=reader">Antihistamines</a>
|
|
</div><ul><li class="half_rhythm"><div><a href="/books/n/livertox/CyclizineChlorcycl/?report=reader">Cyclizine</a>, <a href="/books/n/livertox/Dimenhydrinate/?report=reader">Dimenhydrinate</a>, <a href="/books/n/livertox/Hydroxyzine/?report=reader">Hydroxyzine</a>, <a href="/books/n/livertox/Meclizine/?report=reader">Meclizine</a>, <a href="/books/n/livertox/Promethazine/?report=reader">Promethazine</a></div></li></ul></li><li class="half_rhythm"><div>Cannabinoid Receptor Agonists</div><ul><li class="half_rhythm"><div><a href="/books/n/livertox/Dronabinol/?report=reader">Dronabinol</a>, <a href="/books/n/livertox/Nabilone/?report=reader">Nabilone</a>, Tetrahydrocannabinol</div></li></ul></li><li class="half_rhythm"><div>Phenothiazines [See <a href="/books/n/livertox/AntipsychoticAgents/?report=reader">Antipsychotic Agents</a>]</div><ul><li class="half_rhythm"><div><a href="/books/n/livertox/Chlorpromazine/?report=reader">Chlorpromazine</a>, <a href="/books/n/livertox/Prochlorperazine/?report=reader">Prochlorperazine</a></div></li></ul></li><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/S5HT3RcptAntagonist/?report=reader">Serotonin 5-HT3 Receptor Antagonists</a>
|
|
</div><ul><li class="half_rhythm"><div><a href="/books/n/livertox/S5HT3RcptAntagonist/?report=reader">Alosetron</a>, <a href="/books/n/livertox/S5HT3RcptAntagonist/?report=reader">Dolasetron</a>, <a href="/books/n/livertox/S5HT3RcptAntagonist/?report=reader">Granisetron</a>, <a href="/books/n/livertox/S5HT3RcptAntagonist/?report=reader">Ondansetron</a>, <a href="/books/n/livertox/S5HT3RcptAntagonist/?report=reader">Palonosetron</a></div></li></ul></li><li class="half_rhythm"><div>Substance P/Neurokinin 1 Receptor Antagonists</div><ul><li class="half_rhythm"><div><a href="/books/n/livertox/Aprepitant/?report=reader">Aprepitant</a>, <a href="/books/n/livertox/Aprepitant/?report=reader">Fosaprepitant</a>, <a href="/books/n/livertox/Fosnetupitant/?report=reader">Fosnetupitant</a>, <a href="/books/n/livertox/Rolapitant/?report=reader">Rolapitant</a></div></li></ul></li><li class="half_rhythm"><div>Miscellaneous</div><ul><li class="half_rhythm"><div><a href="/books/n/livertox/Amisulpride/?report=reader">Amisulpride</a>, Dexamethasone, <a href="/books/n/livertox/Metoclopramide/?report=reader">Metoclopramide</a>, <a href="/books/n/livertox/Trimethobenzamide/?report=reader">Trimethobenzamide</a></div></li></ul></li></ul><p>Acid peptic disease/antiulcer agents that include antacids, the histamine type 2 receptor blockers (H2 blockers), and the proton pump inhibitors (PPIs). These agents are some of the most commonly taken medications and are very well tolerated, most being available both by prescription and over-the-counter. While many of these drugs are approved for use in duodenal and gastric ulcer disease, their major use is for acid reflux and indigestion. Agents discussed in LiverTox include the following, which are linked to the specific drug record:</p><ul><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/H2ReceptorBlockers/?report=reader">Histamine H2 Receptor Antagonists (H2 Blockers)</a>
|
|
</div><ul><li class="half_rhythm"><div><a href="/books/n/livertox/Cimetidine/?report=reader">Cimetidine</a>, <a href="/books/n/livertox/Famotidine/?report=reader">Famotidine</a>, <a href="/books/n/livertox/Nizatidine/?report=reader">Nizatidine</a>, <a href="/books/n/livertox/Ranitidine/?report=reader">Ranitidine</a></div></li></ul></li><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/ProtonPumpInhibitors/?report=reader">Proton Pump Inhibitors</a>
|
|
</div><ul><li class="half_rhythm"><div><a href="/books/n/livertox/Lansoprazole/?report=reader">Dexlansoprazole</a>, <a href="/books/n/livertox/Omeprazole/?report=reader">Esomeprazole</a>, <a href="/books/n/livertox/Lansoprazole/?report=reader">Lansoprazole</a>, <a href="/books/n/livertox/Omeprazole/?report=reader">Omeprazole</a>, <a href="/books/n/livertox/Pantoprazole/?report=reader">Pantoprazole</a>, <a href="/books/n/livertox/Rabeprazole/?report=reader">Rabeprazole</a></div></li></ul></li></ul><p>Cathartics, laxatives or agents for constipation include bulk forming agents, osmotic agents, stool wetting agents, nonspecific stimulants, prokinetic agents and agents that increase fluid secretion. Many of these therapies are not systemically absorbed and none are considered particularly hepatotoxic. Naldemedine and naloxegol are opioid antagonists and are used to treat the constipation associated with opioid use. Not all of these agents are discussed in LiverTox, but those that are have links to the specific drug record:</p><ul><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/Bisacodyl/?report=reader">Bisacodyl</a>
|
|
</div></li><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/Cascara/?report=reader">Cascara Sagrada</a>
|
|
</div></li><li class="half_rhythm"><div>Castor Oil</div></li><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/Docusate/?report=reader">Docusate</a>
|
|
</div></li><li class="half_rhythm"><div>Fiber, Bran</div></li><li class="half_rhythm"><div>Lactulose</div></li><li class="half_rhythm"><div>Magnesium Sulfate</div></li><li class="half_rhythm"><div>Methylcellulose</div></li><li class="half_rhythm"><div><a href="/books/n/livertox/Naldemedine/?report=reader">Naldemedine</a> (Opioid Antagonist)</div></li><li class="half_rhythm"><div><a href="/books/n/livertox/Naloxegol/?report=reader">Naloxegol</a> (Opioid Antagonist)</div></li><li class="half_rhythm"><div><a href="/books/n/livertox/Plecanatide/?report=reader">Plecanatide</a> (for Chronic Idiopathic Constipation)</div></li><li class="half_rhythm"><div><a href="/books/n/livertox/Prucalopride/?report=reader">Prucalopride</a> (for Chronic Idiopathic Constipation)</div></li><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/Senna/?report=reader">Senna</a>
|
|
</div></li></ul><p>Inflammatory bowel disease encompasses several disorders, most commonly ulcerative colitis and Crohn colitis. Agents can be classified as 5-aminosalicyclic acid (5-ASA) based agents, immunosuppressive drugs, antitumor necrosis factor agents, corticosteroids, antibiotics and miscellaneous. Agents discussed in LiverTox include the following, which are linked to the specific drug record:</p><ul><li class="half_rhythm"><div>5-Aminosalicyclic Acid (5-ASA) Derivatives</div><ul><li class="half_rhythm"><div><a href="/books/n/livertox/Mesalamine/?report=reader">Balsalazide</a>, <a href="/books/n/livertox/Mesalamine/?report=reader">Mesalamine</a>, <a href="/books/n/livertox/Mesalamine/?report=reader">Olsalazine</a>, <a href="/books/n/livertox/Mesalamine/?report=reader">Sulfasalazine</a></div></li></ul></li><li class="half_rhythm"><div>Immunosuppressive Agents</div><ul><li class="half_rhythm"><div><a href="/books/n/livertox/Azathioprine/?report=reader">Azathioprine</a>, <a href="/books/n/livertox/Mercaptopurine/?report=reader">Mercaptopurine</a>, <a href="/books/n/livertox/Methotrexate/?report=reader">Methotrexate</a></div></li></ul></li><li class="half_rhythm"><div>
|
|
<a href="/books/n/livertox/TNFAntagonists/?report=reader">Tumor Necrosis Factor Antagonists</a>
|
|
</div><ul><li class="half_rhythm"><div><a href="/books/n/livertox/Adalimumab/?report=reader">Adalimumab</a>, <a href="/books/n/livertox/Certolizumab/?report=reader">Certolizumab</a>, <a href="/books/n/livertox/Golimumab/?report=reader">Golimumab</a>, <a href="/books/n/livertox/Infliximab/?report=reader">Infliximab</a></div></li></ul></li><li class="half_rhythm"><div>Miscellaneous</div><ul><li class="half_rhythm"><div><a href="/books/n/livertox/Metronidazole/?report=reader">Metronidazole</a>, <a href="/books/n/livertox/Natalizumab/?report=reader">Natalizumab</a>, Vedolizumab</div></li></ul></li></ul><p><b>Irritable bowel syndrome</b> or functional bowel disease is a common, but not well understood syndrome or collection of symptoms marked by variable degrees of diarrhea and constipation with abdominal bloating and pain. Symptomatic therapies with antidiarrheal agents, drugs for constipation, analgesics, prokinetic agents or antispasmotics are often applied. Medications developed specifically for irritable bowel syndrome include agents that affect specific gastrointestinal receptors or hormones and include tegaserod, alosetron, linaclotide, plecanatide, prucalopride, and lubiprostone. None of these agents, however, is particularly hepatotoxic. Eluxadoline is a unique agent that is used to treat diarrhea-predominant irritable bowel syndrome. It is a mixed opioid receptor agonist (mu) and antagonist (delta) and can cause spasm of the sphincter of Oddi and pancreatitis accompaniend by marked serum aminotransferase elevations. Linaclotide and plecanatide are guanylate cyclase C receptor agonists and are used to treat chronic idiopathic constipation or "constipation predominant" irritable bowel syndrome. Similarly, cisapride, prucalopride and tegaserod are serotonin type 4 receptor agonists that are used for chronic idiopathic constipation. Agents discussed in LiverTox include the following, which are linked to the specific drug record:</p><ul><li class="half_rhythm"><div>Antimuscarinics/Antispasmodics [See <a href="/books/n/livertox/Anticholinergics/?report=reader">Anticholinergic Agents</a>]</div><ul><li class="half_rhythm"><div>Dicyclomine, <a href="/books/n/livertox/Glycopyrrolate/?report=reader">Glycopyrrolate</a>, <a href="/books/n/livertox/Hyoscyamine/?report=reader">Hyoscyamine</a>, <a href="/books/n/livertox/ScopolamineMethscop/?report=reader">Methscopolamine</a></div></li></ul></li><li class="half_rhythm"><div>Prokinetic Agents [See <a href="/books/n/livertox/S5HT4RcptAgonist/?report=reader">Serotonin 5-HT4 Receptor Agonists]</a></div><ul><li class="half_rhythm"><div><a href="/books/n/livertox/S5HT3RcptAntagonist/?report=reader">Alosetron</a>, <a href="/books/n/livertox/S5HT4RcptAgonist/?report=reader">Cisapride</a>, Domperidone, <a href="/books/n/livertox/Linaclotide/?report=reader">Linaclotide</a>, <a href="/books/n/livertox/Lubiprostone/?report=reader">Lubiprostone</a>, <a href="/books/n/livertox/Metoclopramide/?report=reader">Metoclopramide</a>, <a href="/books/n/livertox/Plecanatide/?report=reader">Plecanatide</a>, <a href="/books/n/livertox/Prucalopride/?report=reader">Prucalopride</a>, <a href="/books/n/livertox/S5HT4RcptAgonist/?report=reader">Tegaserod</a></div></li></ul></li><li class="half_rhythm"><div>Opioid receptor mixed agonist/antagonist; Other</div><ul><li class="half_rhythm"><div><a href="/books/n/livertox/Eluxadoline/?report=reader">Eluxadoline</a>, <a href="/books/n/livertox/Tenapanor/?report=reader">Tenapanor</a></div></li></ul></li></ul></div></div><div id="GastrointestinalAgen.ANNOTATED_BIBLIOGRA"><h2 id="_GastrointestinalAgen_ANNOTATED_BIBLIOGRA_">ANNOTATED BIBLIOGRAPHY</h2><p>References updated: 25 April 2019</p><ul class="first-line-outdent"><li><div class="bk_ref" id="GastrointestinalAgen.REF.zimmerman.1999">Zimmerman HJ. H1 Receptor antagonists. Miscellaneous drugs and diagnostic chemicals. In, Zimmerman, HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999: pp. 717-8.<div><i>(Single author review of hepatotoxicity published in 1999).</i></div></div></li><li><div class="bk_ref" id="GastrointestinalAgen.REF.reuben.2011">Reuben A. Hepatotoxicity of immunosuppressive drugs. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier, 2011, pp. 569-91.<div><i>(Review of hepatotoxicity of drugs for inflammatory bowel disease).</i></div></div></li><li><div class="bk_ref" id="GastrointestinalAgen.REF.sharkey.2018">Sharkey KA, MacNaughton WK. Pharmacotherapy for gastric acidity, peptic ulcers, and gastroesophageal reflux disease. In, Brunton LL, Hilal-Dandan R, Knollman BC, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 13th ed. New York: McGraw-Hill, 2018, pp. 909-20.<div><i>(Textbook of pharmacology and therapeutics).</i></div></div></li><li><div class="bk_ref" id="GastrointestinalAgen.REF.sharkey.2018_1">Sharkey KA, MacNaughton WK. Gastroinestinal motility and water flux, emesis, and biliary and pancreatic disease. In, Brunton LL, Hilal-Dandan R, Knollman BC, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 13th ed. New York: McGraw-Hill, 2018, pp. 921-44.<div><i>(Textbook of pharmacology and therapeutics).</i></div></div></li><li><div class="bk_ref" id="GastrointestinalAgen.REF.macnaughton.2018">MacNaughton WK, Sharkey KA. Pharmacotherapy of inflammatory bowel disease. In, Brunton LL, Hilal-Dandan R, Knollman BC, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 13th ed. New York: McGraw-Hill, 2018, pp. 945-54.<div><i>(Textbook of pharmacology and therapeutics).</i></div></div></li></ul></div><div id="bk_toc_contnr"></div></div></div><div class="fm-sec"><h2 id="_NBK548487_pubdet_">Publication Details</h2><h3>Publication History</h3><p class="small">Last Update: <span itemprop="dateModified">April 25, 2019</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div></div><h3>Publisher</h3><p><a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Gastrointestinal Agents. [Updated 2019 Apr 25].<span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"><a href="/books/n/livertox/GarciniaCambogia/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="small-screen-next"><a href="/books/n/livertox/GaucherDiseaseAgents/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
|
|
|
|
|
|
|
|
|
|
<!-- Book content -->
|
|
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js"> </script>
|
|
|
|
|
|
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal104 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
|
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
|
|
|
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3968615.js" snapshot="books"></script></body>
|
|
</html>
|