From the Guidelines
Loperamide is the most effective and recommended medication to slow down bowel movements, with a typical dose of 4 mg initially, followed by 2 mg every 2-4 hours or after every unformed stool, not exceeding 16 mg per day 1. When considering medications to slow down bowel movements, several options are available, including opioids and antimotility agents.
- Loperamide, an opioid receptor agonist, is the preferred choice due to its local activity in the gut and minimal systemic absorption, reducing stool weight, frequency of bowel movements, urgency, and fecal incontinence in acute and chronic diarrhea 1.
- Other opioids, such as codeine phosphate, can be used, but loperamide is generally preferred due to its lack of sedative and addictive effects 1.
- Antimotility agents, such as diphenoxylate with atropine (Lomotil), can also be effective, but may have anti-cholinergic effects, such as dry mouth 1.
- It is essential to monitor patients for the risk of paralytic ileus, especially when using high-dose loperamide 1.
- For chronic conditions, such as irritable bowel syndrome with diarrhea, prescription medications like eluxadoline (Viberzi) or tricyclic antidepressants may be prescribed 1.
- Patients should be advised to stay hydrated while taking these medications and to seek medical attention if diarrhea persists beyond two days, is accompanied by high fever, or contains blood 1.
- Additionally, medications with anticholinergic properties, such as antimotility agents, should be used with caution, as they may increase the risk of complications from diarrhea, particularly in patients with bacterial infections like C. difficile or Clostridium perfringens 1.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Mechanism of Action In vitro and animal studies show that loperamide hydrochloride acts by slowing intestinal motility and by affecting water and electrolyte movement through the bowel. Loperamide binds to the opiate receptor in the gut wall Consequently, it inhibits the release of acetylcholine and prostaglandins, thereby reducing propulsive peristalsis, and increasing intestinal transit time. Pharmacodynamics Loperamide prolongs the transit time of the intestinal contents It reduces daily fecal volume, increases the viscosity and bulk density, and diminishes the loss of fluid and electrolytes.
Loperamide is a drug that can slow down bowel movements by:
- Slowing intestinal motility
- Reducing propulsive peristalsis
- Increasing intestinal transit time
- Reducing daily fecal volume 2
From the Research
Drugs to Slow Down Bowel Movements
- Loperamide is a commonly used drug to slow down bowel movements, with studies showing its effectiveness in treating acute and chronic diarrhea 3, 4, 5, 6.
- It 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.
- Loperamide has been compared to other drugs such as diphenoxylate and codeine, with studies showing that it is superior in providing symptomatic control of chronic diarrhea 3, 6.
- The drug has also been shown to be effective in treating irritable bowel syndrome (IBS) with diarrhea as a main symptom, with significant advantages in stool consistency, pain, and urgency 7.
- Common side effects of loperamide include abdominal pain, distention, bloating, nausea, vomiting, and constipation, but it is generally well tolerated at recommended nonprescription doses 4, 5.
- Loperamide has a longer duration of action than diphenoxylate and does not appear to exert opiate activity in man at normal therapeutic doses, making it a safe and effective treatment option 3, 5.