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or, "What should I do if I have diarrhea, loose stools, or my medications are giving me the runs?"

Side effects from medications are pretty common, but fortunately most symptoms are generally mild and can be remedied with relatively easy treatments.  As medicine makes progress in the treatment of HIV and AIDS, the newer medications are generally easier to take and less sickening than some of the older treatments.  Additionally as more and more treatments are found, it becomes easier and easier to find treatments that suit all patients much better.

The most important thing to do about symptoms and side effects is to report them to your healthcare provider promptly and completely.  If your healthcare provider is aware of your symptoms and problems, your provider can provide recommendations about treatments and changes in your treatment that can decrease or even eliminate the symptoms that you are dealing with. 

Please note that the information below should not come before the advice of your healthcare provider because only that person knows all of your medications and all of your conditions. 

Possible Causes
HIV Drugs
saquinavir (Fortovase)
atovaquone (Mepron)
AIDS-related illness
cytomegalovirus colitis
HIV enteropathy/malabsorption
disseminated MAC
Food poisoning
E coli
Ameba histolytica
Other drugs
almost any antibiotic
excessive fiber supplement
irritable bowel
excessive fat intake in diet
colon surgery or removal
dietary supplements (Ensure, Sustacal, etc.)
lactose intolerance
Explanation and Possible Solutions
Important:  Do not stop any medications that you think may be causing the diarrhea until you have spoken with your healthcare provider.  If you absolutely MUST stop a suspected medication, stop all of your antiretroviral medications at the same time.  Do not stop just the suspected medication or you might lose the effectiveness of the remaining drugs.

Fluid intake is essential for all diarrhea.  Drink as much as you expel if not more.  Do not stop drinking to stop the diarrhea.  Drink water or any other clear fluids.  If you are not drinking enough fluids, the amount of urine you produce will be noticeably diminished and your urine will be darker.  Adjust your fluid intake to keep your urine flow and color normal.  Avoid high fat foods (hamburgers, pizza, etc.) and dairy products when you are having diarrhea.  If you have food poisoning or AIDS-related diarrhea, you may need additional testing, fluids and antibiotic treatments.  Remember to drink only bottled or filtered water if your CD4-lymphocytes are less than 200.

Drug-related diarrhea:  for all diarrhea, fluid is the most important therapy.  If possible the offending drug (e.g. nelfinavir or lopinavir/ritonavir, etc.) should be replaced.

The following options may be considered if the cause of the diarrhea cannot be diagnosed and/or treated/eliminated:
1.  Fiber supplementation may help.  Use psyllium fiber or methyl cellulose 1-4 tablespoons per day in at least 8 ounces of water or fruit juice per tablespoon of supplement.  Fiber is a stool normalizer: it firms up soft stools and diarrhea and it softens hard stools.  Fluid intake is essential for diarrhea itself and for fiber therapy.  Fiber therapy is proven effective for nelfinavir-associated diarrhea.
2.  Calcium carbonate or Tums.  One tablet twice a day may decrease the diarrhea associated with nelfinavir.
3.  Kaopectate or Pepto-Bismol and generics of either of these products may help.  Pepto-Bismol and generics of it may cause your stool to become very dark or black.
4.  Loperamide (Imodium) may be taken as often as every 4 hours to firm up soft stools.  Taking excessive dosage may constipate you.  This medication is available without a prescription.

Diphenoxylate (Lomotil) is a very mild narcotic that can be used for diarrhea up to 8 pills per day or every 4 hours as needed.  Taking excessive dosage may constipate you.  This medication requires a prescription.
6.  Morphine or codeine.  Low doses of other opiates such as morphine or codeine may be used in certain cases where it is important for you to stay on the treatment that is causing moderate or severe diarrhea.  It is important not to stop the morphine suddenly if you have been taking it for more than 3 or 4 days in a row steadily.  If you take too much morphine, you can get constipated.  Morphine may cause nausea.  This medication requires a written prescription each time it is filled.

Other causes of diarrhea:  Consult with your healthcare provider if diarrhea is not clearly drug-related and/or severe and/or associated with fever or other worrisome symptoms.

Diagnosis of non-drug related diarrhea:  It is usually critically important to collect some of your diarrhea for analysis.  Basically you collect some stool that you have expelled into a "pan" and place it in small lab containers.  These containers may be stored for up to several days in your refrigerator.  Although this is not very pleasant, its necessary and safe for you to do so.


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