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Pocket Guide to
GASTROINTESTINAL
DRUGS
Edited by
M. Michael Wolfe | Robert C. Lowe
Pocket Guide to
Gastrointestinal Drugs
 Pocket Guide to
Gastrointestinal
Drugs

Edited by

M. Michael Wolfe, MD
Chair, Department of Medicine
MetroHealth Medical Center;
Charles H. Rammelkamp, Jr. Professor of Medicine
Case Western Reserve University School of Medicine
Cleveland, OH, USA

Robert C. Lowe, MD
GI Fellowship Director
Boston Medical Center;
Associate Professor of Medicine
Boston University School of Medicine
Boston, MA, USA
This edition first published 2014 © 2014 by John Wiley & Sons, Ltd.
Registered office:
John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
Editorial offices:
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apply for permission to reuse the copyright material in this book please see our website at www.
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with the UK Copyright, Designs and Patents Act 1988.
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Library of Congress Cataloging-in-Publication Data
Pocket guide to gastrointestinai drugs / edited by M. Michael Wolfe, Robert C. Lowe.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-118-48157-8 (paperback)
I. Wolfe, M. Michael, editor of compilation. II. Lowe, Robert C., 1966- editor of compilation.
[DNLM: 1. Gastrointestinal Agents–therapeutic use–Handbooks. 2. Gastrointestinal Agents–
pharmacology–Handbooks. 3. Gastrointestinal Diseases–drug therapy–Handbooks. QV 39]
RM365
615.7’3–dc23
2013041991
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print
may not be available in electronic books.
Cover image: iStock #10849434 © Mordolff
Cover design by Meaden Creative
Set in Palatino LT Std 9/12 pt by Aptara Inc., New Delhi, India

1 2013
 Contents

List of contributors, xi
Preface, xvi

PART I: UPPER GI TRACT

1 Prokinetic agents and antiemetics, 3

Hemangi Kale and Ronnie Fass
Prokinetics, 3
Antiemetic agents, 7
Recommended reading, 14

2 Proton pump inhibitors, 15

Wanda P. Blanton and M. Michael Wolfe
Introduction, 15
Mechanism of action, pharmacodynamics, kinetics, 15
Clinical use and dosing, 18
Adverse effects/safety, 27
Recommended reading, 28

3 Histamine H2-receptor antagonists, 31

Kentaro Sugano
Introduction, 31
Mechanism of action, 31
Pharmacology, 33
Clinical effectiveness, 40
Adverse events, 41
Recommended reading, 42

v
vi | Contents

4 Prostaglandins and other mucosal protecting agents, 44

Carlos Sostres and Angel Lanas
Introduction of drug class, 44
Physicochemical properties, 45
Formulations and recommended dosages, 46
Mechanism of action, 47
Drug interactions, 48
Pharmacokinetics, 49
Clinical effectiveness, 49
Toxicity, 51
Pregnancy classes, 52
Other mucosal protecting agents, 52
Recommended reading, 54

PART II: SMALL AND LARGE INTESTINE

5 5-HT modulators and other antidiarrheal

agents and cathartics, 59
Albena Halpert and Douglas Drossman
Introduction, 59
5-HT modulators used in the management of
GI disorders, 59
5-HT agents approved in the US for
specific GI indications, 60
Medications used for the treatment of chronic constipation, 71
Medications used for the treatment of narcotic-induced
constipation, 76
Antidiarrheal agents, 76
Conclusion, 80
Recommended reading, 80

6 5-aminosalicylates, 82
Hannah L. Miller and Francis A. Farraye
Introduction, 82
Preparations, 82
Clinical use and efficacy, 84
Pharmacology: preparations and dosing, 87
Mechanism of action, 89
Bioavailability and metabolism, 89
 Contents | vii

Adverse effects and toxicity, 91

Pregnancy, 93
Drug interactions (package inserts), 94
Precautions and contraindications, 94
Special considerations: effectiveness in colorectal
cancer prevention, 96
Conclusion, 97
Recommended reading, 97

7 Immunosuppressive agents, 100

Lev Lichtenstein and Gerald M. Fraser
Introduction, 100
Thiopurines, 100
Low-dose methotrexate (MTX), 106
Calcineurin inhibitors, 111
Recommended reading, 114

8 Biological agents, 117

Gert Van Assche
Biological agents approved to treat IBD, 117
Optimal treatment strategies with anti TNF therapies in IBD, 119
Safety of biological agents in IBD, 120
Emerging biologicals, 121
Recommended reading, 121

PART III: LIVER AND PANCREAS

9 Interferons, 125
Robert C. Lowe
Introduction, 125
Mechanism of action, 125
Pharmacology, 126
Clinical effectiveness, 127
Toxicity, 128
Interferon types with generic and
brand names, 129
Pregnancy classes, 130
Initial interferon dosing regimens for chronic hepatitis C, 130
Recommended reading, 131
viii | Contents

10 Nucleoside analogs, 133

Uri Avissar and David P. Nunes
Introduction, 133
Mechanism of action, 135
Pharmacology, 137
Clinical effectiveness, 139
Nucleoside analogs, 141
Nucleotide analogs, 146
Summary, 147
Recommended reading, 148

11 Ursodeoxycholic acid, chelating agents, and zinc in the

treatment of metabolic liver diseases, 150
Andrew K. Burroughs and James S. Dooley
Ursodeoxycholic acid, 150
Treatment of copper overload, 155
Recommended reading, 162

12 Agents for the treatment of portal hypertension, 165

Karen L. Krok and Andrés Cárdenas
Introduction, 165
Nonselective beta-blockers (NSBB), 166
Nitrates, 169
Vasopressin analogs, 169
Somatostatin analog, 170
Midodrine, 171
Albumin, 172
Loop diuretics, 172
Aldosterone antagonist, 174
Aquaretics, 174
Disaccharides, 175
Antibiotics, 176
Recommended reading, 177

13 Pancreatic enzymes, 179

Steven J. Czinn and Samra S. Blanchard
Introduction, 179
Mechanism of action, 180
Dosing and schedule of administration, 180
 Contents | ix

Monitoring therapy, 183

Adverse effects, 183
Recommended reading, 184

PART IV: ANTIMICROBIALS AND VACCINES

14 Antibiotics for the therapy of gastrointestinal diseases, 187

Melissa Osborn
Introduction, 187
Pharmacologic properties, 187
Clinical uses, 195
Recommended reading, 202

15 Antimicrobials for parasitic diseases, 204

Joachim Richter
5-Nitroimidazoles, 204
Benzimidazoles, 206
Ivermectin, 211
Praziquantel, 212
Treatment dosages, 214
Recommended reading, 216

16 Vaccines for viral hepatitides, 219

Savio John and Raymond T. Chung
Hepatitis A vaccination, 219
Hepatitis B vaccination, 222
Recommended reading, 227

17 Rotavirus and other enteric vaccinations, 229

Christopher J. Moran and Esther J. Israel
Rotavirus vaccination, 229
Typhoid fever vaccination, 232
Recommended reading, 233

PART V: NUTRITION AND PROBIOTICS

18 Parenteral and enteral nutrition feeding formulas, 237

Dominic N. Reeds and Beth Taylor
Introduction, 237
Indications for nutrition support, 237
Energy and macronutrient requirements, 237
x | Contents

Protein, 238
Carbohydrate, 239
Lipids, 239
Enteral liquid feeding formulations, 239
Disease-specific formulas, 244
Selection of an appropriate enteral formula, 245
Implementation of enteral nutrition, 245
Parenteral nutrition, 245
Summary, 247
Recommended reading, 247

19 Probiotics, 249
Christina M. Surawicz
Introduction, 249
Pharmacology, 250
Mechanisms of action, 251
Clinical indications, 251
Safety/toxicity, 255
Summary, 255
Recommended reading, 256

Index, 259
 List of contributors

Uri Avissar, MD
Boston Medical Center
Assistant Professor of Medicine
Boston University School of Medicine
Boston, MA, USA
Samra S. Blanchard, MD
Associate Professor
Division Head, Pediatric Gastroenterology and Nutrition
University of Maryland School of Medicine
Baltimore, MD, USA
Wanda P. Blanton, MD
Assistant Professor of Medicine
Section of Gastroenterology
Boston Medical Center
Boston University School of Medicine
Boston, MA, USA
Andrew K. Burroughs, MB. BCh Hons, FEB, FEBTM,
Hon DSc (Med), FRCP, FMedSci
Consultant Physician and Hepatologist
The Royal Free Sheila Sherlock Liver Centre
Royal Free London NHS Foundation Trust;
Professor of Hepatology
Institute for Liver and Digestive Health
University College London
London, UK
Andrés Cárdenas, MD, MMSc, AGAF
Faculty Member and Senior Specialist
Institute of Digestive Diseases and Metabolism
University of Barcelona
Hospital Clinic
Barcelona, Spain

xi
xii | List of contributors

Raymond T. Chung, MD
Director of Hepatology, Medicine Service
Massachusetts General Hospital;
Associate Professor of Medicine
Harvard Medical School
Boston, MA, USA
Steven J. Czinn, MD
Professor and Chair, Department of Pediatrics
University of Maryland School of Medicine
Baltimore, MD, USA
James S. Dooley, BSc, MB, BS, MD, FRCP
Emeritus Reader in Medicine
Institute for Liver and Digestive Health
University College London;
Consultant Hepatologist
The Royal Free Sheila Sherlock Liver Centre
Royal Free London NHS Foundation Trust
London, UK
Douglas Drossman, MD
Adjunct Professor of Medicine and Psychiatry
University of North Carolina;
Co-director Emeritus
University of North Carolina Center for Functional GI and Motility
Disorders
Drossman Center for the Education and Practice of Biopsychosocial Care
Chapel Hill, NC, USA
Francis A. Farraye, MD, MSc
Clinical Director, Section of Gastroenterology
Boston Medical Center;
Professor of Medicine
Boston University School of Medicine
Boston, MA, USA
Ronnie Fass, MD
Professor of Medicine Care, Western Reserve University;
Director, Division of Gastroenterology and Hepatology
Head, Esophageal and Swallowing Center
MetroHealth Medical Center
Cleveland, OH, USA
Gerald M. Fraser, MD, FRCP
Associate Professor of Medicine
Director, Inflammatory Bowel Disease Unit
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