From the Guidelines
Loperamide can be taken for diarrhea in most cases, with a typical adult dose of 4mg initially, followed by 2mg after each loose stool, not exceeding 8mg per day for over-the-counter use, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1.
Key Considerations
- Loperamide works by slowing intestinal movement and increasing water absorption, which firms up stool and reduces frequency of bowel movements.
- However, it should not be taken if diarrhea is accompanied by high fever, bloody stools, or if it's caused by certain bacterial infections like E. coli, Salmonella, or Clostridium difficile, as it can worsen these conditions 1.
- If diarrhea persists beyond two days despite taking loperamide, or if symptoms worsen, a healthcare provider should be consulted.
- Staying hydrated while taking loperamide by drinking plenty of clear fluids to replace lost electrolytes is crucial.
- People with certain medical conditions like inflammatory bowel disease or liver problems should consult their doctor before using loperamide.
Special Populations
- Loperamide should not be given to children <18 years of age with acute diarrhea, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1.
- For travelers with mild diarrhea, loperamide can be used as a supportive measure, with a starting dose of 2 tablets (4 mg), followed by an additional 2 mg after each loose or liquid stool, with a total dose of up to 16 mg per day 1.
Evidence Summary
- The evidence supporting loperamide in the treatment of mild diarrhea is strong, with studies showing its effectiveness in reducing the frequency of bowel movements and improving symptoms 1.
- However, it is essential to note that loperamide should not be used as a substitute for fluid and electrolyte therapy, and its use should be guided by the severity of symptoms and the presence of underlying medical conditions 1.
From the FDA Drug Label
Loperamide hydrochloride capsules are indicated for the control and symptomatic relief of acute nonspecific diarrhea in patients 2 years of age and older and of chronic diarrhea in adults associated with inflammatory bowel disease.
Yes, you can take loperamide if you have diarrhea, as it is indicated for the control and symptomatic relief of acute nonspecific diarrhea in patients 2 years of age and older 2. However, it is essential to follow the recommended dosage and use it with caution, especially in pediatric patients and those with certain risk factors, as stated in the warnings section of the drug label 2.
From the Research
Loperamide and Diarrhea
- Loperamide is an effective therapy for various diarrheal syndromes, including acute, nonspecific diarrhea, traveler's diarrhea, and chemotherapy-related diarrhea 3.
- It is also effective in treating diarrhea in patients with painless diarrhea or diarrhea-predominant irritable bowel syndrome 3, 4.
- Loperamide has been observed to increase anal sphincter tone, which may lead to improvement of fecal continence in patients with and without diarrhea 3.
Mechanism of Action
- 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 4.
- It has a longer duration of action than diphenoxylate and is available without a prescription 5, 4.
Safety and Efficacy
- Loperamide is generally well tolerated at recommended nonprescription doses, with common side effects related to the impact on bowel motility, such as abdominal pain, distention, bloating, nausea, vomiting, and constipation 3, 4.
- International guidelines support the use of loperamide for the treatment of infectious diarrhea without dysentery 6.
- Loperamide can be used as monotherapy or as an adjunct to antibiotic treatment in immunocompetent adults with acute infectious traveler's diarrhea or community-acquired diarrhea without severe comorbidities 6.