We received a question from a facility that was beginning its implementation of Banatrol Plus: Does it have to be administered TID?
Banatrol Plus does not always need to start TID, it is just that we need to give a recommended starting dose. It is important to understand that one size never fits all in a clinical situation.
The nurse, pharmacist and/or RD should do a review of the medications and supplement – this is the first step for assessing diarrhea. For example some liquid proteins and liquid medications have high osmolalities which promote diarrhea as well as magnesium oxide supplementation. Even  bowel meds such as Colace, Lactulose, Senna, Dulcolax are sometimes overlooked as a source of diarrhea.
One fact that many folks do not know – a low albumin level can cause malabsorption diarrhea. Diarrhea is associated with an ALB < 2.5. While a low albumin is not a measure of nutritional status, a low albumin is associated with edema, including the lining of the GI track which can impair nutrient absorption. In this case, a hydrolyzed liquid protein mixed in 30 mls of water/liquid would be good to add to the Banatrol Plus regimen – timing for the ProSource does not matter. The predigested collagen protein helps with water absorption and also “feeds” the gut flora.
When adjusting the dose of Banatrol Plus to suit the individual, timing is as important as the dosing frequency. Often the diarrhea  or loose stools are resolved by one packet a day. In other cases, such as side affects from oncology treatment it can take 3 a day. Since Banatrol Plus is not a medication but works by solidifying the stool, it can be taken as long as necessary without any contraindications or side affects.
You  should also try to determine when the diarrhea is the worst for the person – give the Banatrol Plus prior to the time of typical occurrence of diarrhea. The nurse should be able to figure out the best time to give the Banatrol Plus  – the time also needs to match usual medication administration or meal times.