Loperamide
Loperamide is an opioid drug, developed in Belgium and marketed in 1973, used to alleviate the symptoms of acute diarrhoea, including travellers’ diarrhoea, and to manage chronic diarrhoea caused by intestinal disorders, including inflammatory bowel disease (ulcerative colitis and Crohn’s disease).
How Does Loperamide Work?
Loperamide alleviates diarrhoea by slowing down accelerated muscular contractions in the intestine. This helps by increasing the time that material remains in the intestine so that more water can be removed from the faeces. Although it is an opioid, related to narcotics, like morphine, it does not affect the central nervous system.
Loperamide Dosage
Loperamide is available as a liquid (1 mg per teaspoon), tablet and capsule (2 mg), taken orally. For acute diarrhoea, dosing for adults and children 12 years of age and older is generally 4 mg (2 capsules) for the first dose, then 2 mg (1 capsule) after each loose bowel movement until symptoms subside, with a maximum of 16 milligrams per day.
For chronic diarrhoea, dosing is usually by a schedule (two or three times daily). For children younger than 12, consult with a physician, as dosing may be different depending on your child’s age. Read instructions carefully and take exactly as directed. If symptoms do not improve within 48 hours for acute diarrhoea (or within 10 days for chronic diarrhoea), or if a fever or bloody stool develops, get medical advice.
How Long Does a Course of Loperamide Last?
For acute diarrhoea, a course should last no more than two days. For chronic diarrhoea, including inflammatory bowel disease, your doctor will likely prescribe a maintenance course of loperamide for daily use over an extended period to control symptoms.
How Effective is Loperamide?
Loperamide is a very effective diarrhoea treatment for both acute and chronic forms and is similar in effectiveness to diphenoxylate.
Loperamide Side Effects
Loperamide is generally well tolerated, but side effects do occur. They are usually mild and include abdominal pain, constipation, fatigue, vomiting, dizziness, drowsiness and dry mouth. If these symptoms are severe or do not go away, tell your doctor. If you experience difficulty breathing, itching, hives or a skin rash, call your doctor immediately.
What Other Medications Affect Loperamide?
If you are taking cholestyramine, you should take loperamide at least 2 hours before or after the dose of cholestyramine, as this drug will prevent the loperamide from being absorbed. Drugs used to accelerate muscular intestinal contractions will counteract loperamide.
Who Should Not Take Loperamide?
Avoid using loperamide if a fever is present or if there is blood in the stool. It is not recommended for use against the symptoms of cholera, Campylobacter, Shigella, salmonella, certain strains of E. coli or in cases of acute colonic distension.
Loperamide is not recommended for children under the age of two years. Reports of paralysis of the intestine and distension of the abdomen have been reported, although they are rare. The majority of these instances occurred in cases of acute dysentery or overdose with children of this age group. In 1990, Pakistan banned all paediatric formulations of loperamide because of several deaths resulting from its use.
No conclusive studies exist concerning the use of loperamide in pregnant women. It is not known if loperamide is secreted in breast milk. Speak to your doctor if you are pregnant, plan to become pregnant or are nursing.
