Can I give loperamide (Loperamide) to a 1-year-old child with diarrhea?

From the Guidelines

No, you should not give loperamide to a 1-year-old child. According to the most recent and highest quality study, loperamide is not recommended for use in children under 2 years of age due to serious safety concerns, including the risk of respiratory depression, central nervous system depression, and even death in young children 1. For a 1-year-old with diarrhea, focus instead on preventing dehydration by offering plenty of fluids like oral rehydration solutions (such as Pedialyte), breast milk, or formula. Continue feeding the child their normal diet as tolerated.

Key Considerations

• Diarrhea in young children is usually caused by viral infections that resolve on their own within a few days.
• The child's immature digestive and metabolic systems cannot safely process loperamide, and the risks far outweigh any potential benefits.
• If your child has diarrhea that is severe, contains blood, lasts more than 24 hours, or is accompanied by fever over 102°F (38.9°C), vomiting, or signs of dehydration (decreased urination, dry mouth, no tears when crying), contact your pediatrician immediately.

Management of Diarrhea in Children

• Oral rehydration solutions are the mainstay of treatment for diarrhea in children.
• Breast milk or formula should be continued as tolerated.
• Antimotility drugs like loperamide should be avoided in children under 18 years of age with acute diarrhea 1.

From the FDA Drug Label

Loperamide hydrochloride is contraindicated in pediatric patients less than 2 years of age due to the risks of respiratory depression and serious cardiac adverse reactions Pediatric patients may be more sensitive to CNS effects, such as altered mental status, somnolence, and respiratory depression, than adults. The answer is no, loperamide should not be given to a 1-year-old child due to the risks of respiratory depression and serious cardiac adverse reactions 2.

• Contraindication: Loperamide hydrochloride is contraindicated in pediatric patients less than 2 years of age.
• Risks: Respiratory depression and serious cardiac adverse reactions.

From the Research

Loperamide Administration to a 1-Year-Old

• The use of loperamide in infants and young children with acute diarrhea is not recommended, as stated in a study published in 1995 3.
• A double-blind placebo-controlled trial conducted in 1995 found that high-dose loperamide may cause potentially harmful side-effects in a small number of patients 3.
• Another study published in 1981 found that loperamide at a dose of 0.2 mg/kg/day had no significant effect on the course of acute gastro-enteritis in early childhood 4.
• Loperamide is generally well tolerated at recommended nonprescription doses, but common side effects include cramps and nausea 5, 6.
• It is essential to consider the potential risks and benefits of administering loperamide to a 1-year-old, as the medication may have adverse effects, especially when taken in high doses or combined with other substances 7.

Considerations for Loperamide Use

• Loperamide works by decreasing peristalsis and fluid secretion, resulting in longer gastrointestinal transit time and increased absorption of fluids and electrolytes from the gastrointestinal tract 5.
• The medication has a longer duration of action than diphenoxylate and minimal central nervous system effects due to its low oral absorption and inability to cross the blood-brain barrier 5.
• However, taking many times above the normally recommended dose can be dangerous, with cardiovascular, respiratory, and neurological adverse events 7.