Dr. Pavia-Thanks so much for answering my question a couple of weeks ago regarding how may Immodium it is safe to take in a single day. I do have one more important question that has been troubling me however. When I take Viracept (I also take Combivir), my viral load is kept in check (undetectable) but I have almost pure water diarrhea coming out unless I am extremely careful about taking a bunch of Immodium regularly throughout the day WITHOUT fail EVERY day. This is my question-What is this drug, Viracept, really doing to my insides which causes my body to have such extemely watery diarrhea. I really want to understand what the drug is REALLY doing to my intestines or whatever that would make my body have such exteme diarrheal symptoms. Please help me with this. I think it is important to really know what effect this drug has on my body in this regard. Thanks in advance! - KAL

Dear KAL,

Why a drug causes diarrhea, especially viracept is a great question, but in the case of viracept we don't have a clear idea. It may imitate one of the hormone like substances in the gut which controls motility, it may stimulate one of the receptors that tells your gut to move, but as far as I know,Agouron has not been able to find out yet. They continue to look into it.

There is no evidence that I know of that the gut changes, that there is any inflamation or permanent change. Most folks with Viracept diarrhea get better within days if not hours of stopping.

So, it seems to be safe in the long run (if not very pleasant), but watch out for weight loss, which might indicate malabsorption. You may wish to talk to your doctor about a trial of oat bran tablets or calcium tablets to decrease the need for immodium. Good luck

ATP