loperamide, Imodium; Kaopectate II; Imodium A-D; Maalox Anti-Diarrheal (cont.)
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
DOSING: In adults and children 12 years of age and older, the usual dose is 4 mg initially, followed by 2 mg after each loose stool. The maximum dose is 16 mg/day (8 mg if self medicating).
For chronic diarrhea 4-8 mg per day may be administered after control is achieved.
The dose for acute diarrhea in children is: age 8 to 12 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 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 a loose stool.
Chronic diarrhea in children is treated with 0.08-0.24 mg/kg/d divided into two doses, one dose given every 12 hours. For traveler's diarrhea children 6-12 years old receive 2 mg after the first lose stool then 1 mg after each subsequent stool. Children older than 12 receive 4 mg initially then 1 mg after each loose stool.
The maximum daily dose for traveler's diarrhea is 4 mg (6-8 years old), 6 mg (6-12 years old), and 8 mg (>12 years old).
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.
Reference: FDA Prescribing Information
Last Editorial Review: 3/1/2012
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