High stomal outputs following interactions between opioid and opioid-like derivatives with CYP inducers
Background: International guidelines for the management of high output stoma (HOS) commonly involve the use of opioids and opioid-like derivatives, such as loperamide, to mitigate the risk or impact of intestinal failure. However, these agents often have significant drug-drug interactions that may r...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-07-01
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| Series: | Intestinal Failure |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950456224000332 |
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| author | Elizabeth SL Low Katrina Tan Darren Wong |
| author_facet | Elizabeth SL Low Katrina Tan Darren Wong |
| author_sort | Elizabeth SL Low |
| collection | DOAJ |
| description | Background: International guidelines for the management of high output stoma (HOS) commonly involve the use of opioids and opioid-like derivatives, such as loperamide, to mitigate the risk or impact of intestinal failure. However, these agents often have significant drug-drug interactions that may reduce the efficacy of anti-diarrheal pharmacotherapy and risk prolonged dependency on parenteral nutritional and intravenous fluid replacement, if unrecognized. Case report: Two cases of patients prescribed rifampicin for differing indications demonstrate persistent HOS despite traditional management strategies, including maximal doses of anti-diarrheal agents. Rifampicin, a known cytochrome P450 enzyme inducer, increases metabolism of both codeine and loperamide, resulting, in these cases to reduced drug efficacy and intestinal failure. Conclusion: Prescribers must be mindful of the potential drug-drug interactions when co-administering drugs inducing cytochrome P450 expression with opioids commonly used in HOS management. Given the risk of opioid inefficacy and increased stomal outputs, close monitoring and careful drug titration is advised. |
| format | Article |
| id | doaj-art-c6ce690b4b9d47bcb8f8679004602d9c |
| institution | Kabale University |
| issn | 2950-4562 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Intestinal Failure |
| spelling | doaj-art-c6ce690b4b9d47bcb8f8679004602d9c2025-08-20T03:42:43ZengElsevierIntestinal Failure2950-45622024-07-01310003310.1016/j.intf.2024.100033High stomal outputs following interactions between opioid and opioid-like derivatives with CYP inducersElizabeth SL Low0Katrina Tan1Darren Wong2Correspondence to: Department of Gastroenterology, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia.; Department of Gastroenterology, Austin Health, Melbourne, VIC, AustraliaDepartment of Gastroenterology, Austin Health, Melbourne, VIC, AustraliaDepartment of Gastroenterology, Austin Health, Melbourne, VIC, AustraliaBackground: International guidelines for the management of high output stoma (HOS) commonly involve the use of opioids and opioid-like derivatives, such as loperamide, to mitigate the risk or impact of intestinal failure. However, these agents often have significant drug-drug interactions that may reduce the efficacy of anti-diarrheal pharmacotherapy and risk prolonged dependency on parenteral nutritional and intravenous fluid replacement, if unrecognized. Case report: Two cases of patients prescribed rifampicin for differing indications demonstrate persistent HOS despite traditional management strategies, including maximal doses of anti-diarrheal agents. Rifampicin, a known cytochrome P450 enzyme inducer, increases metabolism of both codeine and loperamide, resulting, in these cases to reduced drug efficacy and intestinal failure. Conclusion: Prescribers must be mindful of the potential drug-drug interactions when co-administering drugs inducing cytochrome P450 expression with opioids commonly used in HOS management. Given the risk of opioid inefficacy and increased stomal outputs, close monitoring and careful drug titration is advised.http://www.sciencedirect.com/science/article/pii/S2950456224000332High-output stomaRifampicinDrug-drug interactionCYP inducersOpioids |
| spellingShingle | Elizabeth SL Low Katrina Tan Darren Wong High stomal outputs following interactions between opioid and opioid-like derivatives with CYP inducers Intestinal Failure High-output stoma Rifampicin Drug-drug interaction CYP inducers Opioids |
| title | High stomal outputs following interactions between opioid and opioid-like derivatives with CYP inducers |
| title_full | High stomal outputs following interactions between opioid and opioid-like derivatives with CYP inducers |
| title_fullStr | High stomal outputs following interactions between opioid and opioid-like derivatives with CYP inducers |
| title_full_unstemmed | High stomal outputs following interactions between opioid and opioid-like derivatives with CYP inducers |
| title_short | High stomal outputs following interactions between opioid and opioid-like derivatives with CYP inducers |
| title_sort | high stomal outputs following interactions between opioid and opioid like derivatives with cyp inducers |
| topic | High-output stoma Rifampicin Drug-drug interaction CYP inducers Opioids |
| url | http://www.sciencedirect.com/science/article/pii/S2950456224000332 |
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