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    Suggest treatment for nausea and diarrhea while on Vancomycin

Posted on Mon, 10 Jul 2017 in Medicines and Side Effects
Question: My wife was prescribed vancomycin for 14 days, 250 mg 4x daily. for a c.diff. infection and SIBO. She was also prescribed cholestyramine resin, 9 g, to take at bedtime dissolved in liquid, to address excessive bile pooling in her stomach, as well as to bind to the c.diff. and help with its expulsion. As expected, the vancomycin gave her nausea, cramping and diarrhea almost immediately. Half way into the course of the antibiotic she added (on her own initiative ) Florastor (Saccharomyces boulardii) 500 mg. 2x daily, a probiotic yeast that is not killed by antibiotics and that some studies have shown to be helpful in preventing a c.diff. relapse, and rebuilding a good flora environment in the colon after antibiotic therapy.. She finished the course of vancomycin four days ago, but is still taking the cholestyramine resin and the Florastor. She is also still experiencing nausea and intestinal cramping, as well as loose stools (not exactly diarrhea). I would have thought that the vancomycin would be out of her system by now. So, could it be the cholestyramine resin and/or the Florastor that is causing the continued nausea and cramping? Suggestions?
Answered by Dr. Noble Zachariah 58 minutes later
Brief Answer:
More likely to be due to cholestyramine. Discussion follows

Detailed Answer:

Welcome and thanks for your query.
Cholestyramine is known to produce adverse effects like abdominal pain, nausea, vomiting, belching and diarrhoea. It is possible that it may be the cause of your wife's symptoms.
Saccharomyces boulardii is unlikely to cause diarrhea and is often used to suppress the pathogen causing diarrhea. Adverse reaction can occur if your wife is allergic to yeast or has a weak immune system.
As for Vancomycin, it is not the drug in the blood that causes the symptoms but its effect on the gut. It may destroy some of the good bacteria in the gut along with the Clostridium difficile and produce adverse effects.
I would suggest your wife stopping the cholestyramine and see if her symptoms improve.
Do get back to me if you have further queries.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Noble Zachariah 12 minutes later
Thank you for your reply. She took the Cholestyramine last night at 10:00 p.m. and hasn't taken any more of this drug since then. It is now over 14 hours since she last took it, and she is still having nausea and abdominal pain, but no diarrhea. Do you think that it could still be the Cholestyramine causing this? She hasn't taken anything else except the Florastor (Saccharomyces boulardii).
Answered by Dr. Noble Zachariah 2 hours later
Brief Answer:
Symptoms can last a couple of days.

Detailed Answer:
Thanks for the feedback.
The symptoms can persist till the cholestyramine is passed out in the stools. This may take a couple of days and the stools will be devoid of black color.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Noble Zachariah

Internal Medicine Specialist

Practicing since :1974

Answered : 2276 Questions


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