Medication used to manage a High Output Stoma or Fistula

What medications may be prescribed and how are they taken?

Your medical team may prescribe medicines which reduce the amount of secretions in your gut or slow the speed at which food moves through your bowel (please refer to the literature provided with the medication).

Omeprazole/Lansoprazole/Pantoprazole

• Used to reduce the amount and acidity of fluid produced by the stomach and soothe the gut lining
• Take once or twice daily as advised by your doctor
• Available in capsule, tablet or oro-dispersible form
• Can be given IV if your team do not think the oral form is suitable for you

Loperamide/Imodium

• Used to slow down the gut
• Available in 2mg capsules, tablets or oro-dispersible form
• Capsules may not be absorbed so tablets or oro-dispersible are the best
• The dose can vary from 2mg to 16mg taken four times a day. Your doctor or pharmacist will advise you of the dose to take
• You should monitor the effect on the stool consistency
• Take 30 minutes before meals 

Codeine Phosphate

• Used to slow down the gut
• The dose is usually 30-60mg, taken four times a day although smaller doses can be used
• Take 30-60 minutes before food

These medications are often used in combination with each other and the dose may vary depending on your output. Your consultant or GP will advise you of this.

Multi-vitamins and minerals

If you have a high output stoma/ or fistula and are unable eat a high fibre diet for longer than a month or are unable to manage 5 small portions of fruit and vegetables daily, you may require a multivitamin. If you are on parenteral nutrition these vitamins may already be in your feed. However, this is not always possible, and you may be prescribed an oral alternative if you have the ability to absorb or an injection. This will be decided by your nutrition support team. Please let your team know if you are taking or plan to take any multivitamins or other medications as this can result in misinterpretation of your bloods. 

Vitamin B12 injections

If you have had the last part of your small bowel (ileum) removed, you may require vitamin B12 injections every 3 months to prevent anaemia. Your doctor will advise you on this.