Causes
- Direct and indirect toxic effects of treatment
- Cytotoxic: Taxanes, anthracyclines, antimetabolites (fluoropyrimidines), platinums; Irinotecan (early and late)
- Targeted: VEGF inhibitors, EGFR inhibitors, HER2 inhibitors, CDK 4/6 inhibitors, ALK inhibitors
- Abdominal/pelvic radiation
- Surgical intervention of GI tract
- Malignancy
- Infection
Management
- Atropine: irinotecan early diarrhea. 0.25 mg IV/SC q15 min PRN, max 1 mg
- Loperamide (Imodium) 4mg PO at first sign of diarrhea then 2mg PO q 2h until diarrhea free for 12 hours. Do not take > 12 tablets/day
- Diphenoxylate/atropine (Lomotil) 5 mg PO 4x/day. May alternate with loperamide
- Octreotide (Sandostatin) 50-150 mcg SQ q 8h; up to 500 mcg SQ q8h
- Non-Pharmacological: Hydration, Electrolytes, Diet modification-BRAT, Probiotics (controversial)
