Loperamide (Oral)

Loperamide is sold under different brand names, including Diamode, Imodium, Imodium A-D, Imogen, Imotil, Imperim, Kaodene A-D, and Kao-Paverin Caps.

Overview

Loperamide is an oral medication administered to provide relief from diarrhea. This antidiarrheal medication is approved for use by adults and children six years and older. The medicine works by slowing the intestinal motility while affecting water and electrolyte movement through the patient's bowel. It works by binding to the opiate receptor in the wall of the gut. Consequently, this inhibits the release of prostaglandins and acetylcholine to reduce propulsive peristalsis while increasing intestinal transit time. In addition, loperamide increases the tone of anal sphincter, hence reducing incontinence and urgency.

This medication is available in the following forms:

  • Tablet
  • Capsule
  • Liquid
  • Chewable tablet
  • Solution
  • Capsule, Liquid Filled
  • Suspension

Conditions Treated

  • Sudden diarrhea

Type Of Medicine

  • Antidiarrheal

Loperamide side effects

Alongside the intended effects, loperamide does come with some unwanted effects. Some of these side effects are mild and tend to go away as the body adjusts to the medication. However, some perindopril side effects can be severe with a need for medical attention.

Check with your healthcare provider immediately if you experience any of the following side effects while on loperamide treatment:

  • Constipation
  • Bloating
  • Abdominal pain accompanied by nausea and vomiting
  • Loss of appetite

Check with your healthcare provider as soon as possible if you experience the following serious side effects while on loperamide treatment.

  • Fast or irregular heartbeats
  • Fainting
  • Severe stomach/abdominal pain
  • Severe constipation/nausea/vomiting
  • Severe dizziness

Allergic reactions

Very serious allergic reactions to loperamide are rare. However, seek medical help as soon as you can if you experience symptoms of allergic reactions such as itching/rashes on the face, throat, and tongue, breathing difficulty, and severe dizziness. Anaphylactic shock is rare.

Nervous system

Loperamide overdose may cause severe depression to the nervous system. This is characterized by tiredness and general fatigue, drowsiness, and dizziness.

Dermatological side effects

Dermatological side effects of loperamide include rashes, urticaria, pruritus, and angioedema. Rare cases of bullous eruptions including Stevens-Johnson Syndrome, erythema multiforme, and Toxic Epidermal Necrolysis (TEN) have been reported.

Genitourinary side effects

Urinary retention has been reported as a result of long-term use of this medication

Gastrointestinal side effects

Long-term loperamide use has been linked to appendicitis, toxic megacolon, and paralytic ileus. Gastrointestinal side effects associated with loperamide are often due to the patient's underlying medical condition and include vomiting, nausea, abdominal cramps, dyspepsia, and anorexia.

Call your healthcare provider for medical advice about these loperamide side effects. You may also report the side effects to the FDA at 1-800-FDA-1088.

Loperamide dosage

If you are using an over-the-counter drug for self-treatment, it is important that you read and understand the medicine information before taking the drug.

Take this drug orally, usually after passing loose stool, or as directed by your healthcare provider. The dosage should be based on your condition as well as response to treatment. In children, loperamide dosage should be based on the age and body weight. Adults should not take more than eight milligrams within 24 hours of self-medication, or 16 milligrams within 24 hours if under the doctor's direction.

Chewable loperamide tablets should be taken on an empty stomach. Chew the tablet thoroughly before swallowing.

If you are taking rapidly dissolving tablets, dry your hands before opening the blister pack to remove the medication. Do not break the tablet while opening the blister pack. Place the tablet on your tongue and allow to dissolve before swallowing with saliva. Do not split, crush, or break the medication before taking it. Do not remove the tablet from its pack if you are not ready to take it.

Diarrhea can cause a serious loss of body fluid (dehydration). It is important that you take a lot of water to replenish the lost fluids and electrolytes. Inform your healthcare provider right away if you develop signs of dehydration such as decreased urination, extreme thirst, muscle cramps, fainting, and general body weakness. You may also need to adopt a bland diet during the treatment period to reduce irritation to your intestines and stomach. Seek more information from your healthcare provider.

Tell your healthcare provider if your condition does not improve after two days of medication, or if you develop new symptoms. Seek immediate medical attention if you spot blood in stool, develop a fever, or an uncomfortable fullness/swelling of the abdomen, or if you think you might be suffering from a serious medical condition.

If your doctor has prescribed loperamide to treat ongoing diarrhea, inform them if your diarrhea does not stop after 7 days of continued treatment.

Dosing information

Treating acute diarrhea in adults

  • Capsule, tablet, and liquid loperamide forms

Starting dose: 4 mg taken orally after the first loose stool

Maintenance dose: 2 mg taken orally after each loose stool, without exceeding 16 mg within 24 hours. Clinical improvement should be observed within 48 hours.

  • Chewable tablets

Starting dose: 4 mg taken orally after the first stool

Maintenance dose: 2 mg taken orally after each subsequent loose stool. Do not exceed 8 mg within 24 hours.

Treating chronic diarrhea in adults

  • Capsules, tablets, and liquid forms

Starting dose: 4 mg taken orally once followed by 2 mg taken orally after each loose stool. Do not exceed 16 mg in within 24 hours.

Maintenance dose: the average daily maintenance dose should be 4 to 8 mg. clinical improvement should be observed after 10 days of medication.

Pediatric treatment for acute diarrhea

  • 2 to 6 years (13 to 20 kg body weight)

Liquid formulation should be used in this age group

Starting dose: 1 mg administered orally 3 times a day on the first day

Maintenance dose: 0.1 mg/ kg body weight after each loose stool. Do not exceed the initial dose

  • 6 to 8 years old (20 to 30 kg body weight)

Tablets, liquid, and capsule forms

Starting dose: 2 mg taken orally twice a day on the first day

Maintenance dose: 0.1 mg/kg body weight taken orally after each loose stool, but not exceeding the starting dose.

Chewable tablet

Starting dose: 2 mg taken orally after the first loose stool

Maintenance dose: 1 mg taken orally after each subsequent loose stool, but not more than 4 mg in 24 hours.

  • 8 to 12 years old (greater than 30 kg)

Tablets, liquid, and capsules

Starting dose: 2 mg taken orally 3 times per day on the first day

Maintenance dose: 0.1 mg/kg body weight taken orally after each loose stool, but not exceeding 6 mg within the 24-hour period.

Chewable tablets

Starting dose: 2 mg taken orally for the first stool

Maintenance dose: 1 mg taken orally after each subsequent loose stool, but not exceeding 6 mg in within the 24-hour period.

  • 12 to 18 years old

Chewable tablets, tablets, capsules, and liquid

Starting dose: 4 mg taken orally after the first loose stool

Maintenance dose: 2 mg taken orally after each subsequent loose stool, but not exceeding 8 mg in 24-hour period.

Pediatric dosage for chronic diarrhea

Children less than 2 years old

Therapeutic dosage for treating chronic diarrhea in children under 2 years using loperamide is yet to be established.

Missed dose

Since this medication is taken as needed, it is unlikely that you will have a dosing schedule. If you are taking loperamide regularly, take the missed dose as soon as you can. However, you may skip the missed dose if it is almost time for your next scheduled dose. Do not make up for missed dose by double dosing.

Overdose

Seek emergency help or call the Poison Help line in your area at 1-800-222-1222. Symptoms of loperamide overdose include drowsiness, dizziness, severe cramping, vomiting, bloating, and urinating less than usual.

Loperamide interactions

Although certain medications should never be administered together at all, there are cases where two different medicines may be prescribed even if there is risk of an interaction. In such cases, your healthcare provider may recommend a change of dosage, or propose other precautionary measures. When you are taking loperamide, it is especially important that your healthcare provider knows if you are on any of the medications listed below.

Using loperamide with any of the following medications is not recommended. However, this combination may be required in some cases. If both medicines are prescribed together, your healthcare provider may recommend a change of dosage or how you take both drugs.

  • Saquinavir
  • Eliglustat
  • Simeprevir
  • Gemfibrozil

Other interactions

Certain foods should not be taken while on some medications as this might cause an interaction. Using alcohol and tobacco products while on certain medications may also cause an interaction or affect the efficiency of the medication. Discuss with your healthcare provider the use of loperamide with food, alcohol, and tobacco products.

Other medical problems that may affect the efficiency of loperamide

Certain underlying medical conditions may also affect the use of this medication. Be sure to inform your healthcare provider if you have any of the following medical problems:

  • Severe case of colitis'use of loperamide may trigger a more serious problem to the colon
  • Dysentery¬†' this condition may worsen when you are on loperamide treatment
  • Liver disease 'the chance of severe central nervous system (CNS) side effects may be greater when patients with liver disease use this medication.

Loperamide warnings

Loperamide may cause severe or life-threatening changes to the heart rhythm, especially if you take more than the recommended amount. Tell your healthcare provider if you have a history of prolonged QT interval, an irregular heartbeat, or low blood potassium levels.

Taking more than the recommended dosage of loperamide can cause serious heart problems that can be fatal at times. Do not this medication in larger doses, more often, or for a longer period than as recommended by your healthcare provider.

Loperamide should never be administered to children younger than 2 years of age because of the risk of serious heart and breathing problems.

Loperamide should not be administered to patients in whom peristalsis is to be avoided due to the increased risk of sequelae. Loperamide should be stopped immediately if the patient develops constipation, ileus, or abdominal distention.

Cases of allergic reactions, including anaphylaxis and anaphylactic shocks are rare. However, this medication should be stopped immediately and the healthcare provider alerted if symptoms worsen, diarrhea persists for more than 48 hours while on medication, if stool has blood, or if the patient experiences abdominal swelling or bulging.

Loperamide should be used with caution in patients with hepatic dysfunction. Additionally, these patients should be closely monitored for signs of toxicity to the central nervous system.

Loperamide should be administered with caution to younger children because of the greater response variability in this age group. Dehydration, especially in toddlers and younger children, may further influence the variability of response to medication.

Loperamide may impair your thinking and reactions. Do not drive, operate machinery, or perform tasks that require you to be alert until you know how your body responds to this medication.

Avoid being dehydrated or overheated during the treatment period. Follow your healthcare provider's instructions about the type and amount of liquids you should take to replenish the lost body fluid.

Some antibiotic medications can cause diarrhea, which may be a sign of a new infection. If you are on antibiotic medication and you have watery diarrhea with blood in it, call your healthcare provider. Do not take loperamide to stop diarrhea unless your healthcare provider advises you to do so.

Loperamide storage

Loperamide should be stored at room temperature (20 to 25 degrees C). Keep the medication away from pets and children in the original container to avoid accidental administration. Keep the medication away from direct sunlight, heat and moisture. Additionally, keep the medicine from freezing.

Do not flush the medication down the sink or toilet unless advised to do so. Consult your pharmacist on how to properly dispose of expired medications or medications that you no longer use.

Summary

Loperamide works by slowing down the pace of digestion so that the small intestines can have more time to absorb the nutrients from the food you eat. Besides treating diarrhea, loperamide is also used to reduce the amount of stool in patients with ileostomy (re-directing of the bowel through a surgical opening in the stomach's opening).

Do not treat diarrhea with this medication if you have a fever, or if your stool has mucus or blood. Contact your healthcare provider instead for proper diagnosis and treatment.

For safe and effective use of loperamide:

  • Follow your doctor's prescription to the letter
  • Follow the manufacturer's package direction if you are self-medicating

Alongside this medication, it is important that you replace lost fluids and energy by adopting a proper diet. During the first 24 hours of diarrhea, be sure to take a gelatin and drink a lot of caffeine-free clear fluids such as decaffeinated cola or tea, ginger ale, and broth. During the next 24 hours, take bland foods such as bread, cooked cereals, applesauce, and crackers. Avoid fruits, vegetables, alcoholic beverages, and fried or spicy foods as these can worsen your condition.

If you have lost too much body fluid due to prolonged diarrhea, a serious condition (dehydration) may develop. Check with your healthcare provider as soon as possible if you exhibit the following symptoms of dehydration:

  • Dizziness and lightheadedness
  • Decreased urination
  • Increased thirst
  • Dryness of mouth
  • Wrinkled skin

Links