From the Guidelines
Loperamide is contraindicated in children under 18 years of age with acute diarrhea due to the risk of central nervous system depression and respiratory depression, which can be life-threatening in young children. The primary concern is that loperamide works by slowing intestinal motility, but in children, especially those under 18 years, the use of antimotility agents like loperamide is not recommended as it may worsen certain infectious diarrheas by delaying pathogen clearance 1. Additionally, dehydration from diarrhea can progress rapidly in children, and using loperamide may mask this critical symptom while not addressing the underlying fluid and electrolyte losses.
Key Considerations
- The blood-brain barrier is not fully developed in young children, allowing the medication to potentially cross into the central nervous system and cause serious adverse effects.
- Loperamide should be avoided at any age in suspected or proven cases where toxic megacolon may result in inflammatory diarrhea or diarrhea with fever 1.
- For children with acute diarrhea, the recommended approach is oral rehydration therapy rather than antimotility agents like loperamide.
- If medication is needed for older children, it should only be used under strict medical supervision, with careful attention to proper dosing based on weight and age, and only after other causes of diarrhea such as bacterial infection have been ruled out.
Recommendations
- Antimotility drugs like loperamide should not be given to children <18 years of age with acute diarrhea 1.
- Loperamide may be given to immunocompetent adults with acute watery diarrhea, but with caution and under medical supervision 1.
From the FDA Drug Label
Loperamide hydrochloride capsules are contraindicated in pediatric patients less than 2 years of age due to the risks of respiratory depression and serious cardiac adverse reactions Postmarketing cases of cardiac arrest, syncope, and respiratory depression have been reported in pediatric patients less than 2 years of age Pediatric patients may be more sensitive to CNS effects, such as altered mental status, somnolence, and respiratory depression, than adults.
Loperamide is contraindicated in children under 2 years of age due to the risks of respiratory depression and serious cardiac adverse reactions. These risks are supported by postmarketing cases of cardiac arrest, syncope, and respiratory depression in pediatric patients less than 2 years of age 2, 2, 2.
From the Research
Loperamide Contraindication in Children
- Loperamide is contraindicated in children due to the risk of adverse effects, particularly paralytic ileus 3.
- A case study reported a 2-year-old girl who developed paralytic ileus after taking loperamide for acute diarrhea, highlighting the potential dangers of using this medication in young children 3.
- The mechanism of action of loperamide, which decreases peristalsis and fluid secretion, can lead to increased risk of ileus and other gastrointestinal complications in children 4.
- While loperamide is generally well-tolerated in adults, its use in children is not recommended due to the potential for serious adverse effects 5.
Potential Risks and Complications
- Loperamide can cause cardiac arrhythmias, respiratory, and neurological adverse events, particularly when taken in high doses or combined with other medications 6, 7.
- The risk of these adverse effects is increased in children, who may be more susceptible to the toxic effects of loperamide 3.
- Additionally, loperamide can interact with other medications, such as CYP3A4 inhibitors, which can elevate its concentrations and increase the risk of adverse effects 4, 7.