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Drug-Induced Abdominal Pain

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Drug-induced abdominal pain is generally a reversible complication caused by some drugs. Its prevention and management are explained in the article.

Medically reviewed by

Dr. Ghulam Fareed

Published At October 13, 2022
Reviewed AtJune 21, 2023

Introduction:

Some drugs can irritate the gastrointestinal tract leading to abdominal pain and other disorders. The drug can cause inflammation of the gastrointestinal tract walls, often resulting in abdominal pain and other complications. Various disorders serve various abdominal pain depending on the effect of drugs. Treatment for drug-induced abdominal pain and disorders can be avoidance of drug administration, alteration in doses of drugs, and replacement of drugs with another one with fewer side effects.

Which Drugs Can Cause Abdominal Pain?

1) Aspirin: It affects the inner tissue of your stomach and causes abdominal pain and other issues. Some other pain-relieving drugs can cause abdominal irritation, heartburn, and irritation.

Uses of Aspirin: It is a composition known as acetylsalicylic acid, which reduces pain, inflammation, or fever. It is used just after a heart attack to decrease the chances of death. It is advised in diseases such as rheumatic fever and pericarditis.

2) Antibiotics: These are drugs used to treat bacterial infections in the body. Since it acts on bacteria, it can kill the ‘good’ bacteria in your body and bad or infective bacteria. These good bacteria can be taken through foods known as probiotics. However, some people can suffer from gas, abdominal pain, diarrhea, and nausea after taking antibiotics. Killing good bacteria can cause unbalance in the digestive system and abdominal pain. Some of the common antibiotics are Erythromycin, Amoxicillin, Metronidazole, and Cefoperazone.

3) Opioid Painkillers: Opioids act on opioid receptors to produce morphine-like effects and relieve pain. They also help to anesthetize the pain and provide relief. Some opioids like Hydrocodone and Oxycodone can cause belly cramps, bloating, and constipation.

4) Cholesterol Drugs: When there is an increase in cholesterol levels in the body, the doctor can advise some cholesterol drugs. These drugs can cause abdominal pain and discomfort in some individuals.

Examples of cholesterol drugs are:

  • Statins: These drugs decrease low-density lipids (LDL) and triglycerides and slightly increase high-level lipids (HDL). Their side effects are abdominal pain, cramps, nausea, constipation, and elevation in liver enzymes. Examples of statins are Lovastatin, Pravastatin, and Atorvastatin.
  • Cholesterol Absorption Inhibitors: It helps decrease low-density lipids (LDL) and a slight increase in high-density lipids (HDL). Common side effects are- abdominal pain, muscle soreness, and fatigue. One of the cholesterol inhibitors is Ezetimibe.

5) Iron Supplements: The deficiency of iron leads to reduced oxygen in our cells, called iron deficiency anemia. It can be cured with supplements, which can have side effects like stomach pain and constipation. It can also irritate the esophagus in some cases.

6) Chemotherapy: Therapy with drugs that are used in treating cancers and malignancies. Drugs used for chemotherapy are Gemcitabine, Fluorouracil, Methotrexate, and Cytarabine. These drugs have severe side effects on different body parts, including the abdomen. The complications are abdominal pain, appetite changes, anemia, nausea, vomiting, hair loss, and fatigue.

What Are the Treatments for Abdominal Pain?

The first and most important factor is the alteration in drug doses or replacement of a drug with another drug with fewer side effects on the abdomen. This will help to reduce abdominal pain and other complications.

Medications to Cure Abdominal Pain:

  • For pain due to gas, drugs with simethicone as an ingredient can be used. It is a mild drug that can be administered to babies and children.

  • Antacids can be used for heartburn due to gastroesophageal reflux (GERD).

  • For any other kind of pain, drugs like Acetaminophen (Aspirin-free), Panadol, and Tylenol can be used. NSAIDs should be strictly avoided as they cause abdominal pain.

Which Are Other Drug-Induced Abdominal Disorders?

  • Pill Esophagitis: Ulceration at the junction between the proximal and middle third of the esophagus due to excessive tablets and capsule consumption. Symptoms include painless dysphagia (difficulty in swallowing). However, individuals who suffer from pill esophagitis have normal esophageal (no other clinical symptoms). Drugs that can cause pill esophagitis can be Doxycycline, NSAIDs (non-steroidal anti-inflammatory drugs, and iron tablets.

  • Medication-Induced Diarrhea and Constipation: Drugs such as Furosemide, Levothyroxine, and Ibuprofen are associated with constipation. Some of the cardiovascular medications causing constipation are calcium channel blockers and Verapamil.

  • Metformin-Induced Gastrointestinal Symptoms: Metformin is the drug used to treat type-2 diabetes or other conditions like polycystic ovarian syndrome. It causes complications in the gastrointestinal tract, such as diarrhea and nausea. These symptoms can arise due to the malabsorption of substances like vitamin B12 or bile salts. Metformin can act as an agonist at 5-hydroxytryptamine-3 (HT3) receptors in the gastrointestinal system and affects the levels of peptides (ghrelin) important in digestive functions.

  • NSAIDs (Non-steroidal Anti-inflammatory Drugs) Induced Disorders: The side effects of NSAIDs cause gastrointestinal ulceration as they are acidic. Inhibitors of COX-1 can lead to a reduction of bicarbonate and mucous production. It also decreases blood flow and slows epithelial repair NSAIDs also affect the small intestine causing inflammation and ulceration on its lining.

  • Psychotropic Drug-Induced Gastrointestinal Disorders: Antidepressants which are tricyclic agents, can lead to constipation. At the same time, some new selective serotonin reuptake inhibitors (SSRIs) can be associated with nausea and diarrhea for a short time. Some psychotropic medications are- Olanzapine, Quetiapine, and Risperidone.

What Is the Management of Drug-Induced Complications?

  • Symptoms such as abdominal pain, diarrhea, and constipation are age and dose-specific; older ages and excess administration of drugs worsen these symptoms. So proper awareness and cautious instructions should be mentioned while prescribing medicines.

  • Laxatives can be prescribed with antipsychotic drugs that cause constipation in most cases.

  • Proton pump inhibitors or H2 blockers can be prescribed with antibiotics to prevent gas, abdominal pain, and ulceration.

How to Use Medicines Therapeutically?

Thorough knowledge of the adverse effects of medications can help the physician to administer them as a therapeutic agent other than their functions.

Some of the drugs are:

  • Verapamil: In poorly controlled diarrhea (due to microscopic colitis), the patient also suffers from hypertension. Prescribing Verapamil and anti-diarrhea drugs can control hypertension and show a prominent constipating effect.

  • Olsalazine: In cases of ulcerative colitis, there is troublesome constipation, described as ‘proximal constipation,’ prevention with a mesalazine-delivering drug is required. Olsalazine is advised as it cures constipation and its secretory effect on the small intestine.

Conclusion:

Many drugs, such as aspirin, antibiotics, or cholesterol-controlling medications, can induce abdominal pain, which is reversible. It can be prevented by regulating drug choice and doses primarily. Aspirin-free medicines, simethicone, and antacids can be used to cure abdominal pain. Some other gastrointestinal complications, like constipation or diarrhea and abdominal pain, are drugs included and can be prevented and cured easily.

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Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology

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