Wednesday, September 12, 2007

The Makers Of Kaopectate Need To Have The Crap Beat Out Of Them.

Kaopectate is effective at relieving diarrhea.

Kaopectate generally produces a bowel movement in 12 to 72 hours.

Kaopectate can be taken to relieve diarrhea cause by antibiotic use.

Kaopectate is not recommended for diarrhea caused by antibiotic use.

I have not lied to you. I can say these things because the asswipes that own the Kaopectate brand name, Chattem, Inc., have taken the original Kaopectate formula containing Attapulgite, which we all knew and loved as the only product to be used for antibiotic-induced diarrhea, and changed it to bismuth subsalicylate, the same ingredient found in Pepto Bismol. Bismuth subsalicylate is not recommended for relief of antibiotic induced diarrhea. It also should not be given to children with viral infections, which will be no source of confusion to people who remember the old "Children's Kaopectate" brand.

Wait, there's more. The caring professionals at Chattem have also decided to change the name of Surfak, a stool softening laxative to........Kaopectate.

So....Kaopectate makes you poop, and Kaopectate stops you from pooping. Clear as mud isn't it?

To be fair, Chattem isn't the only company that does this kind of marketing bullshit.

Maalox is Pepto Bismol as well. Except when it's just regular Maalox.

Remember, you can't give Pepto Bismol to children. unless it's children's Pepto, which is only an antacid, unlike Pepto Bismol, which works as an anti-nausea and anti-diarrheal as well. Proctor & Gamble chose to make this distinction clear by using the same color scheme and font for both Children's Pepto and Pepto Bismol, which are, again, two entirely different products. That's why the labels look almost exactly the same. And they both use the word "Pepto." Because they're different.

Tylenol is also Benadryl, which is also Nytol.

Midol is Tylenol with a dash of caffeine, except when Midol is Advil, or when Midol is Aleve.

Neosporin is Micatin, an effective athlete's foot remedy. Except when it's Neosporin the first aid ointment, which is totally ineffective against athlete's foot.

I could go on all night, but I prefer the simplicity of scotch, which is just scotch.



Anonymous said...

Really...there otta be a law against this 'special' kind of insanity, which ensures inaccessibility of basic OTC facts for the masses, (if consider that there's two categories of the knowledgeable--those with ready access and those without access, NOR the mental capability to make sense of it...).

I like to think that part of my pharmacy job is education of the sort that allows folks to make their own best decisions, and just happen to think that the idea should be to make the public more knowledgeable, not increase confusion.

I don't believe it's pharmacy's business nor in the profession's best interest to facilitate a antiquated 'we always dun it dis way' behaviour that can lead to medication error. (Nor do I like having to refigure minims, drams, etc.!)

Anonymous said...

Love this post! I always say this shit at work. Keep it up! Your stress reliever is scotch. My stress reliever is the drugmonkey and the angry pharmacist.

Brian said...

Man, I feel your pain 100%. I'm a pharmacy student/intern who works for a large chain--marketing and advertising are the reasons we can't communicate with patients for shit when it comes to OTC products. All your lectures about the Benadryl that's really Tylenol hit home.

Incidentally, according to one of my professors, attapulgite was removed from the market due to questionable efficacy. It may have been considered the drug of choice at one point, but from what I'm hearing the supporting evidence was weak, much like the recent withdrawal of trimethobenzamide suppositories for nausea in children.

from a little way back said...

Hey DM - I'm putting my site on ice for a little while. I see a lot of traffic comes my way from your site but I don't know when I'll start up again and if I do it may be from an entirely new page. So you can remove The Stat Pharmacist link from your front page. It's a long story.

DrugMonkey said...


Not quite. The people who questioned Attapulgite's effectiveness were the FDA, which has been engaged in a process for longer than I've been alive to make sure all OTC drugs have been proven to be safe and effective. "Proven" means "well done studies." And if a product was allowed on the market before these studies were required, the manufacturer faced a choice of doing the studies or changing a product's formula. Many manufacturers decided it was cheaper to just change their formulas.

It would be a mistake to equate "not proven" with "doesn't work" though. The world was round long before Columbus, and many of us knew Attapulgite would stop antibiotic induced pooping whether there was a study that said so or not.

These days your only hope for the Augmentin runs is to proactively take some probiotics. Your government in action.

Stat Pharmacist,

I'm sorry to hear this. Best of luck to you....

Judy said...

So there's no source of attapulgite any more?

That's a shame.

Don't know what it would do for antibiotic induce pooping, but I did learn that "fiber laxatives" -- the kind WITHOUT any sort of stool softener or actual laxative -- are the bomb for slowing down chemo-induced pooping.

No shit. Or almost none.

Ribeye of your Dreams said...

you lost me at kaopectate LOL. I don't like pepto anyway, usually makes me puke up pink goo when i take it. Just give me an aspirin, or something stronger after the major dental work im having done in october and I'll be happy.

Keep up the good work
Ribeye of your Dreams

brian said...


Yeah, it's the same flavor of legal-regulatory bullshit that has earned Adams Respiratory millions with Mucinex and allowed somebody to patent quinine sulfate. QUININE SULFATE. We are talking about a drug that British soldiers occupying India used for malaria back in the glory days of the Empire.

It's hard to draw the line on some of this stuff from a regulatory standpoint, though. We might all know attapulgite works, but if no one "does the study" someone can always argue that we don't have any evidence-based reason to recommend it. At risk of invoking the slippery slope fallacy, if we can say drug X works "because it's been used for a long time and therefore we know it works," proponents of quack medicine can do the same, at least from a legal-regulatory standpoint (see, for reference, much of herbal medicine--nevermind that they already get the pass because of retarded supplement industry lobbyists). Those people never seem to be thinking about medicine, or even science--they're lawyers.

The lay public doesn't necessarily know the difference, and more importantly, lawyers don't care about the difference. "You didn't do double-blind clinical trials" is damning for the pharmaceutical industry these days. It seems silly to require double-blind trials to prove aspirin works for headaches, but I'm in favor of consistency; I'd like to see everything held to the same standard of evidence if at all possible.

It would just be too awesome if someone did the study; not only would the FDA be satisfied, but pharmacists would be able to feel better about the level of evidence for their recommendations. Of course, as you pointed out, pharma is always on guard regarding its profit margins, so when somebody in accounting determines that it's cheaper to reformulate, that's what they're going to do. They don't care about improving the evidence base because there's no financial incentive, so the ingredient simply disappears as unproven. Argh! This is quite the lose-lose situation. Aside from major overhaul of the drug approval process in the US, what're your thoughts on how this sort of thing should be handled? My only issue is that there are drugs/treatment procedures for which someone did do the study and it was demonstrated that they weren't actually effective for the indication. You've mentioned the efficacy of dextromethorphan in a past post, as I recall, just to use an example. (Here's an n=43 study suggesting DXM is no better than placebo for controlling cough in acute URTI. Not exactly overwhelming, but there're a few other related studies you can look at if you suddenly realize you have no life. And yeah, DXM is still on the market. I'm just musing.)

As an aside, it'd be great if there were some law about how frequently pharma can reformulate its products. It annoys me to no end that the formulation of every cough syrup on the market changes every six months and MDs are still writing for the old stuff, which has long been discontinued. Who in God's name thought it was a good idea to reformulate prescription-only cough syrups with phenylephrine!?


Shalom said...

I've been ranting about this for ages myself. What used to be products are now brand names, some of which (like Sudafed PE) no longer contain any of the original active ingredients. The marketroids look at "Benadryl", for one example, and say, oh look, brand recognition, and we don't even have to pay extra for it. Now there are a bunch of Benadryl-brand products. Imagine what would happen if Coca-Cola suddenly started selling some other kind of soda with the Coke name on it... oh wait, they did that already.

It makes things harder for us, no question. "Doctor said I should take [Benadryl | Sudafed | Tylenol | Dramamine | you-name-it], which of these umpteen products did he mean?" Arrgh.

This isn't the first time that they've reformulated Kaopectate, though. When I was a kid, it was kaolin + pectin (hence the name); attapulgite came later. has some of the history.

Of course you can buy a half kilo of attapulgite from Spectrum and compound it yourself, but I'm not sure of the legality of that.

Anonymous said...

Nursing student here. This shit is wayyy too confusing and we wonder why there are so many med errors and adverse drug reactions and people taking the wrong med for the wrong problems.

Fucking batshit crazy, I tells ya!

Anonymous said...

These freaking companies piss me off too!!! And customers act like we're the idiots when they want to know the dose of a medication and I tell them I need to know the active ingredients. Dont just tell me Sudafed, Maalox, Kaopectate, Triaminic!!!!!!

Bariatric Brat said...

OMG this post just made my head hurt. There is indeed a lot to be said for some single malt therapy.

Sara said...

"Tylenol is also Benadryl.."
I didn't understand until I helped a customer find some sleep aids, and realized Simply Sleep©, made by Tylenol, has the same active ingredient as Benadryl.. which most people like to use to sleep, as well as treat allerigic related stuff.

I feel kinda smart.

anon., CPhT said...

God, I hate retail so much. I don't know how you do it and I wouldn't do it for $10 million a year and all the controlled substances I could keep down.
Last time I got my scripts filled I took some work off the pharmacists' hands by talking to another patient about her sinus congestion. She agreed that the whole phenylephrine substitution was horseshit; said she tried the "new formula" and it didn't work, so she had come back for pseudoephedrine.
I haven't seen the crime stats lately, but I'm willing to bet meth abuse is still a problem...

Anonymous said...

Everyone has missed the "real" reason that keopectate has had the attapulgite pulled. The FDA banned Attapulgite for sale in the U.S. because of studies that indicated it had excessive amounts of lead in it. It started with California and then went national.

Keopectate in the U.S. is marketed by Pharmacia. In Canada it is marketed McNeil labs which is owned by Johnson and Johnson. The Canadians have no such law and continue to manufacture the attapulgite formulation. However, it is difficult to have it sent to the U.S. Some Canadian online pharmacies will send the attapulgite formulation of the liqued kaopectate, but I haven't been able to find the tablet formulation online. Some online Canadian pharmacies sell Fowler's, an attapulgite tablet formulation in 630 mg of per table compared with 750 mg for the old kaopectate. You can get this sent. So, so far attapulgite is still available in Canada if you look for it.


cracker said...

Thank you very much for posting this. You confirmed as I suspected that Kaopectate changed its formula.

It's now exactly the same as Pepto Bismol except for the color. Names are meaningless now because Kaopectate contains neither Kaolin or Pectin any longer.

Damn government bureaucrats. I wish they would leave shit alone that works just fine.

Oh, and I agree with the poster that says DXM is ineffective for relieving a cough. I bought some extra strength time release stuff with DXM in it and it was totally useless. I had to go the doctor for a prescription with codeine in it in order to get an effective cough medicine.

Anonymous said...

Almost afraid to mention this . . .(don't want the DEA following me), BUT, the *a_c_t_u_a_l* formula for the original "Kaopectate" is still formulated for veterinarian use. You can spend a lot for 4oz at the petstores, or you can buy it online by the gallon (and less) for not much $$. I use it myself. Attapulgite probably worked better on just 2 Tbsp. But, the kaolin clay and the pectin works too. We are not talking about hardcore medical problems, mind you. But, it does help for the issues mentioned by others. It is not made to taste good, but it does work. I have always thought that the pink pepto was useless. Never did anything for diarrhea. Maybe OK for a little indigestion.

dean0 said...

I thought that Kopectate was made and sold by upjohn?156

JLF said...
This comment has been removed by the author.
Brenda Ellis said...

Ate at El Maguey- have had the shitzz for 3 days. So is there anything to take or should I build a toilet computer station?

Lori said...

Fascinating... I worked for years in a compounding pharmacy and we used to compound kaolin-pectin suspension primarily to make griseofulvin suspension (some study apparently showed that griseofulvin - which is very poorly absorbed - was absorbed better when mixed with the original KaoPectate). But it was a huge pain in the ass to make (hello - pectin is a bitch to mix smoothly into water) and always had to be massive volumes. Just glad I don't work there very often anymore!

As for OTC brand names - ARG! It's insane. I used to start off any "cough-and-cold" counselling interaction with the comment that the entire aisle was just 4 or 5 active ingredients. That tended to soften them up a bit. Sometimes.