Effect of codeine phosphate, Lomotil, and Isogel on ileostomy function

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Abstract
The effect on ileostomy function of codeine phosphate, Lomotil, or Isogel was tested in 20 subjects at home living a normal life, studied over two 3-day periods on and off treatment. Codeine phosphate 60 mg 3 times daily was associated with a reduction in the mean total weight of ileostomy output and the ileostomy outputs of water, Na and K (P < 0.05). The proportion of fecal solids increased on codeine and the effluent appeared thicker but the output of fecal solids remained unchanged. Mean fecal fat increased on codeine. The transit rate from mouth to stoma was slower in 4 of the 5 subjects on codeine and a further 2 subjects withdrew from the trial with temporary intestinal obstruction while on the drug. Lomotil 2 tablets 3 times daily was associated with a small and statistically not quite significant fall in the mean total weight of ileostomy output and the ileostomy output of water. Na and K outputs in the effluent fell on Lomotil (P < 0.05) but the other parameters remained unchanged. Isogel 15 ml 3 times daily was associated with an increase in the mean total weight of ileostomy output and the ileostomy outputs of water, Na, K and fecal solids (P < 0.01). Although the effluent looked more viscid on Isogel, the proportion of fecal solids was unchanged. Apparently codeine phosphate has a beneficial effect on ileostomy function, reducing the loss of water and electrolytes, while Lomotil has a similar but less effective action in the dosage tested. By contrast, Isogel increases the ileostomy loss of water and electrolytes and will aggravate their depletion in patients with excessive fluid effluents. The increase in fecal fat associated with taking codeine phosphate suggests that it should be stopped before collecting specimens for fecal fat estimations.