I experienced diarrhea from the Irinotecan component of Folfirinox which targets fast dividing cells which the GI tract has. Immodium was not effective for me. My team wrote Rx’s for several anti-diarrheal medications depending on what the insurance company formulary was covering at the time. The anti-diarrheals that were effective for me were Loperamide, Lomax, Lomatil and the generic diphenoxylate atropine. I did not wait until the onset of symptoms to take any of them. I took it proactively starting about 30 hours before administration of chemo to have a consistent therapeutic level in the circulation.

I didn’t want to reduce or eliminate the effectiveness of the oxaliplatin so dealt with it by stimulating circulation in the feet doing foot massaging, warm-water soaks and found walking on warm beach sand was very therapeutic. To lessen the discomfort, I was prescribed 200 mg of gabapentin. A biosimilar medication is Cymbalta. I did 24 cycles of Folfirinox over 24 months. I didn’t experience any improvement in neuropathy until 2.5 years after Folfirinox was completed. At that point there was a slow, steady improvement and it resolved at 7.5 years after finishing treatment.

Long after I went through Folfirinox and neuropathic symptoms, I began reading anecdotal reports of clinics and patients using icing therapy on the extremities to reduce neuropathy. The theory behind it is restricting the blood flow through the capillaries in the hands and feet fo the Oxaliplatin is not coming into contact with tissues and nerves in those areas.There are a few abstracts and articles documenting the technique and it’s effectiveness-
https://learn.colontown.org/topic/managing-neuropathy-and-cold-sensitivity/