GENERIC NAME: loperamide

BRAND NAMES: Imodium; Kaopectate II; Imodium A-D; Maalox Anti-Diarrheal Caplets; Pepto Diarrhea Control.

DRUG CLASS AND MECHANISM: Loperamide is a medication that is used for the relief of acute diarrhea and the management of chronic diarrhea in patients with inflammatory bowel disease (Crohn's disease and ulcerative colitis). The effectiveness of loperamide is comparable to another anti-diarrheal, diphenoxylate (Lomotil). Loperamide reduces diarrhea by slowing the forward propulsion of intestinal contents by the intestinal muscles. Although loperamide is related chemically to narcotics such as morphine, it does not have any of the narcotics pain- relieving effects even at high doses. Loperamide was approved by the FDA in 1976.

PRESCRIPTION: yes (Imodium). no (all other brand names)

GENERIC AVAILABLE: yes

PREPARATIONS: capsules or tablets (2mg); liquid (1 mg per teaspoonsful).

STORAGE: Store at room temperature, 15-30°C (59- 86°F).

PRESCRIBED FOR: Loperamide is used for the relief of acute or chronic diarrhea.

DOSING: In adults and children 12 years of age and older, the usual dose is 4 mg (2 capsules) as a first dose, followed by 2 mg (1 capsule) after each unformed stool. The maximum dose is 16 mg/day. The dose for children is: age 9 to 11 years, 2 mg three times the first day; age 6 to 8 years, 2 mg twice the first day; age 2 to 5 years, 1 mg times three times the first day. After the first day, children less than 12 years of age usually receive a dose of 0.1 mg/kg after an unformed stool.

DRUG INTERACTIONS: Cholestyramine (Questran) binds to loperamide in the intestines and prevents its absorption, thereby reducing the effect of loperamide. Therefore, there should be at least a two hour interval between doses of loperamide and cholestyramine. Some drugs which are used to increase propulsion of intestinal contents theoretically could counteract loperamide. Such drugs include bethanechol (Urecholine), cisapride (Propulsid), metoclopramide (Reglan), and erythromycin.

PREGNANCY: There are no adequate studies of loperamide in pregnant women. However, studies in animals receiving very high doses of loperamide suggest no important, detrimental effects on the fetus. Physicians may use loperamide during pregnancy if its benefits are deemed to outweigh the potential but unknown risks.

NURSING MOTHERS: It is not known if loperamide is secreted in breast milk.

SIDE EFFECTS: Loperamide is generally well- tolerated. The side effects that have been reported during loperamide treatment include abdominal pain, constipation, drowsiness, dizziness, dry mouth, fatigue, nausea, and vomiting.

Last Editorial Review: 7/23/1998

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