Palmer K R, Corbett C L, Holdsworth C D
Gastroenterology. 1980 Dec;79(6):1272-5.
As no adequate comparison of these widely used drugs has been made, we have performed a double-blind cross-over trial in 30 individuals with chronic diarrhea. Each underwent three randomized treatment periods of 4 wk duration. Patients were instructed to increase the daily dose gradually until control was achieved or side effects became intolerable. Stool frequency, consistency, urgency, and incontinence were then compared when a stable dose was reached. Though 2.3 capsules (4.6 mg) of loperamide, 2.3 capsules (103.5 mg) of codeine and 2.5 capsulses (12.5 mg) of diphenoxylate all reduced stool frequency to the same extent, diphenoxylate was significantly less effective in producing a solid stool. Before treatment 95% of patients experienced urgency, sometimes associated with fecal incontinence, often as their major diability. Loperamide and codeine were more effective in relieving this than was diphenoxylate. Side effects, particularly central nervous effects, were greatest with diphenoxylate and least with loperamide. Approximately equal numbers discontinued each preparation; poor control and central-nervous-system side effects were the usual reasons for stopping diphenoxylate and codeine, and abdominal pain and constipation for stopping loperamide. We conclude that both loperamide and codeine phosphate are superior to diphenoxylate in the symptomatic treatment of chronic diarrhea.
由于尚未对这些广泛使用的药物进行充分比较，我们对30例慢性腹泻患者进行了双盲交叉试验。每人接受为期4周的三个随机治疗期。指导患者逐渐增加每日剂量，直至腹泻得到控制或出现难以耐受的副作用。达到稳定剂量后，比较大便频率、性状、急迫感和大便失禁情况。尽管2.3粒胶囊（4.6毫克）的洛哌丁胺、2.3粒胶囊（103.5毫克）的可待因和2.5粒胶囊（12.5毫克）的地芬诺酯均能同等程度地降低大便频率，但地芬诺酯在使大便成形方面效果明显较差。治疗前，95%的患者有急迫感，有时伴有大便失禁，这通常是他们的主要残疾问题。洛哌丁胺和可待因在缓解这一问题上比地芬诺酯更有效。副作用，尤其是中枢神经系统副作用，地芬诺酯最为明显，洛哌丁胺最少。每种制剂停药的人数大致相等；控制不佳和中枢神经系统副作用是停用 地芬诺酯和可待因的常见原因，而腹痛和便秘是停用洛哌丁胺的常见原因。我们得出结论，在慢性腹泻的对症治疗中，洛哌丁胺和磷酸可待因均优于地芬诺酯。
