# Diarrhoea from chemotherapy, targeted therapy and radiotherapy: grading, loperamide, octreotide and when to admit

Source: https://onco.cc/protocols/treatment-induced-diarrhoea-grading-and-management/  
OnCo record `treatment-induced-diarrhoea-grading-and-management` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Treatment diarrhoea can turn dangerous quickly, especially with a low blood count. Drink plenty and start loperamide at the first loose stool if your team has told you to. Call the 24-hour line at once if it does not settle within a day, if there are seven or more stools a day, or with fever, blood, vomiting or dizziness. If cancer tablets are the cause and loperamide fails, stop them and ring.

## Summary

The usual approach, as written by eviQ (Cancer Institute NSW) and NCI PDQ, follows the 2004 expert panel (Benson et al.): grade the diarrhoea with CTCAE, look for complicating features, and split uncomplicated from complicated diarrhoea. Uncomplicated grade 1 or 2 diarrhoea is managed at home with clear fluids, dietary changes and standard-dose loperamide (4 mg, then 2 mg every 4 hours or after each loose stool until 12 hours free of diarrhoea), increased to 2 mg every 2 hours if it persists beyond 24 hours. Grade 3 or 4 diarrhoea, or grade 1 or 2 with cramping, fever, sepsis, neutropenia, bleeding, nausea or vomiting, dehydration or falling performance status, or diarrhoea lasting beyond 48 hours on loperamide, is complicated: it usually needs admission, stool cultures, intravenous fluids, antibiotics and subcutaneous octreotide (100 to 150 micrograms three times daily, escalated to 500 micrograms). MASCC/ISOO recommend octreotide of at least 100 micrograms twice daily when loperamide fails after chemotherapy associated with transplant (level II), and suggest Lactobacillus probiotics to prevent diarrhoea from pelvic radiotherapy (level III). Anticancer treatment is interrupted and the dose modified by the regimen's own rules. Irinotecan, sacituzumab govitecan and neratinib have their own protocols; checkpoint inhibitor diarrhoea is immune colitis and is excluded. The latest ESMO guideline (2018) could not be read.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: chemotherapy-induced diarrhoea; CID; cancer treatment-induced diarrhea; loperamide for chemotherapy diarrhoea; octreotide for chemotherapy diarrhoea; complicated diarrhoea
- Tags: protocol; diarrhoea; supportive-care

## Connected records

- protocols: [Irinotecan: early cholinergic syndrome and late diarrhoea](https://onco.cc/protocols/irinotecan-early-cholinergic-syndrome-and-late-diarrhoea/), [Neratinib: diarrhoea prevention with loperamide or dose escalation](https://onco.cc/protocols/neratinib-diarrhoea-prophylaxis-and-dose-escalation/), [Suspected febrile neutropenia (neutropenic sepsis): the first hour](https://onco.cc/protocols/febrile-neutropenia-first-hour/)
- drugs: [Capecitabine](https://onco.cc/drugs/capecitabine/), [Cetuximab](https://onco.cc/drugs/cetuximab/), [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/), [Idelalisib](https://onco.cc/drugs/idelalisib/), [Irinotecan (and liposomal irinotecan)](https://onco.cc/drugs/irinotecan/), [Panitumumab](https://onco.cc/drugs/panitumumab/), [Pertuzumab](https://onco.cc/drugs/pertuzumab/), [Sacituzumab govitecan](https://onco.cc/drugs/sacituzumab-govitecan/), [Somatostatin analogues (octreotide, lanreotide)](https://onco.cc/drugs/octreotide-lanreotide/), [Sorafenib](https://onco.cc/drugs/sorafenib/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Bowel function after pelvic radiotherapy](https://onco.cc/technologies/bowel-after-pelvic-radiotherapy/), [Probiotics for chemotherapy and radiotherapy diarrhoea](https://onco.cc/technologies/probiotics-treatment-diarrhoea/)
- institutions: [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/), [Multinational Association of Supportive Care in Cancer](https://onco.cc/institutions/mascc/), [National Cancer Institute (NIH)](https://onco.cc/institutions/nci/)
- terms: [CTCAE toxicity grading (grade 3-4 adverse events)](https://onco.cc/terms/ctcae-grading/), [Febrile neutropenia](https://onco.cc/terms/febrile-neutropenia/), [Immune-mediated colitis and diarrhoea](https://onco.cc/terms/immune-colitis/)

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