Chemistry - Kaolin is a naturally occurring hydrated aluminum silicate which is powdered and refined for pharmaceutical use. Kaolin is a white/light, odorless, almost tasteless powder that is practically insoluble in water.
Pectin is a carbohydrate polymer consisting primarily of partially methoxylated polygalacturonic acids. Pectin is a course or fine, yellowish-white, almost odorless with a mucilagenous flavor. It is obtained from the inner rind of citrus fruits or from apple pomace. One gram of pectin is soluble in 20 ml of water and forms a viscous, colloidal solution.
In the United States, the two compounds generally are used together in an oral suspension formulation in most proprietary products.
Storage/Stability/Compatibility - Kaolin/pectin should be stored in airtight containers; protect from freezing. It is incompatible with alkalis, heavy metals, salicylic acid, tannic acid or strong alcohol.
Pharmacology - Kaolin/pectin is thought to posses adsorbent and protective qualities. Presumably, bacteria and toxins are adsorbed in the gut and the coating action of the suspension may protect inflamed GI mucosa. The pectin component, by forming galcturonic acid, has been demonstrated to decrease pH in the intestinal lumen.
In one study in children with acute nonspecific diarrhea, stool fluidity was decreased, but stool frequency, water content and weight remained unchanged. No studies documenting the clinical efficacy of this combination in either human or veterinary species were located.
Uses/Indications - Although its efficacy is in question, kaolin/pectin is used primarily in veterinary medicine as an oral anti-diarrheal agent. It has also been used as an adsorbent agent following the ingestion of certain toxins. Administration may be difficult due to the large volumes that may be necessary to give orally.
Pharmacokinetics - Neither kaolin nor pectin are absorbed after oral administration. Up to 90% of the pectin administered may be decomposed in the gut.
Contraindications/Precautions - There are no absolute contraindications to kaolin/pectin therapy, but it should not be relied on to control severe diarrheas. Kaolin/pectin should also not replace adequate fluid/electrolyte monitoring or replacement therapy in severe or chronic diarrheas.
Adverse Effects/Warnings - At usual doses, kaolin/pectin generally have no adverse effects. Constipation may occur, but is usually transient and associated with high dosages. High doses in debilitated patients or in very old or young patients may rarely cause fecal impaction to occur. In rats, kaolin/pectin has been demonstrated to increase fecal sodium loss in diarrhea.
In humans, kaolin/pectin is only recommended to be used in patients less than 3 years of age or for longer than 48 hours under the direct supervision of a physician.
Overdosage - Overdosage is unlikely to cause any serious effects, but constipation requiring treatment may occur.
Drug Interactions - Kaolin/pectin may inhibit the oral absorption of lincomycin. If both drugs are to be used, administer kaolin/pectin at least 2 hours before or 3-4 hours after the lincomycin dose.
Some evidence exists that kaolin/pectin may impair the oral absorption of digoxin. While the clinical significance of this potential interaction is unknown, it is recommended to separate the dosages as outlined above for lincomycin.
a) 2 - 4 quarts PO per 450 kg body weight bid (Robinson 1987)
b) 1 oz. per 8 kg body weight PO 3-4 times a day (Clark and Becht 1987)
c) Foals: 3 - 4 oz PO q6-8h (authors believe that bismuth subsalicylate is superior) (Martens and Scrutchfield 1982)
Monitoring Parameters -
1) Clinical efficacy
2) Fluid & electrolyte status in severe diarrhea
Client Information - Shake well before using. If diarrhea persists, contact veterinarian. If animal appears listless or develops a high fever, contact veterinarian.
Dosage Forms/Preparations/FDA Approval Status/Withholding Times - There are variety of kaolin/pectin products available without prescription. Several products are labeled for veterinary use; their approval status is not known. Many products that formerly contained kaolin (e.g., Kaopectate®) no longer contain any kaolin, but use attapulgite as the adsorbent.
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