Use of Dihydrocodeine and Similar Opiates in Irritable Bowel Syndrome
The gut itself contains its own opioid receptors that allow opioids which do not enter the CNS in appreciable quantities or at all, following oral administration, such as the pethidine-related drugs loperamide, diphenoxylate and difenoxin, to work in the same fashion in a significant percentage of the population. These drugs also have direct anticholinergic effects which contribute to their action. However the loperamide-like drugs can exacerbate cyclical IBS and have little or no effect on the cramps associated with all major forms of IBS and exacerbate the constipation-predominant manifestation of this condition also when treating chronic IBS a tolerance can develop over time rendering these types of medication ineffective. As a result, the most effective opioids for this spectrum of GI complaints would be whole-opium preparations such as paregoric, laudanum, Dover's Powder, granulated opium, opium in pill form etc., with codeine, morphine, oxycodone and dihydrocodeine working very well also, especially on diarrhoeal and cyclical IBS. Whole opium contains not only morphine and codeine and other narcotic alkaloids but also the alkaloid papaverine, a smooth-muscle relaxant, and other alkaloids, oils, resins and waxes which can help with cramping and other symptoms. Preparations containing both paregoric and extract of belladonna were once available that were probably the strongest and most efficaceous of GI drugs
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