What is the recommended dosage of Loperamide (Imodium)?

From the Guidelines

The standard adult dosage of Imodium (loperamide) for acute diarrhea is 4 mg initially, followed by 2 mg after each loose stool, not exceeding 16 mg per day. This recommendation is based on the most recent and highest quality study available, which suggests that loperamide can be started at an initial dose of 4 mg followed by 2 mg every 2–4 h or after every unformed stool, with a maximum daily dose of 16 mg 1.

Key Considerations

• The dosage may vary depending on the severity of the diarrhea and the individual's response to treatment.
• It is essential to take loperamide with water and to seek medical attention immediately if symptoms persist beyond two days or are accompanied by fever, blood in stool, or severe abdominal pain.
• Loperamide should be avoided in cases of bloody diarrhea, severe colitis, bacterial intestinal infection, or when taking antibiotics that may cause diarrhea.

Special Populations

• Children under 6 years should not take Imodium without medical supervision.
• For children 9-11 years (60-95 lbs), the dosage is 2 mg initially, then 1 mg after each loose stool, with a maximum of 6 mg daily.
• For children 6-8 years (48-59 lbs), the dosage is 1 mg initially, then 1 mg after each loose stool, with a maximum of 4 mg daily.

Mechanism of Action

• Loperamide works by slowing intestinal movement and increasing water absorption, which reduces stool frequency and improves consistency.

Additional Guidance

• The patient should be instructed to record the number of stools and report symptoms of life-threatening sequelae, such as fever or dizziness on standing 1.
• Dietary modifications, such as eliminating lactose-containing products and high-osmolar dietary supplements, may also be recommended 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION 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 (see CONTRAINDICATIONS) Avoid loperamide hydrochloride capsule dosages higher than recommended in adult or pediatric patients 2 years of age and older due to the risk of serious cardiac adverse reactions (See WARNINGS, OVERDOSAGE). (1 capsule = 2 mg) Patients should receive appropriate fluid and electrolyte replacement as needed Acute Diarrhea Adults and Pediatric Patients 13 Years and Older: The recommended initial dose is 4 mg (two capsules) followed by 2 mg (one capsule) after each unformed stool. The maximum daily dose is 16 mg (eight capsules). Pediatric Patients 2 Years to 12 Years of Age: In pediatric patients 2 years to 5 years of age (20 kg or less), the non-prescription liquid formulation (Imodium A-D 1 mg/5 mL) should be used; for ages 6 to 12, either loperamide hydrochloride capsules or Imodium A-D liquid may be used For pediatric patients 2 to 12 years of age, the following schedule for capsules or liquid will usually fulfill initial dosage requirements: Recommended First Day Dosage Schedule Two to five years (13 to 20 kg): 1 mg three times daily (3 mg total daily dosage) Six to eight years (20 to 30 kg): 2 mg twice daily (4 mg total daily dosage) Eight to twelve years (greater than 30kg): 2 mg three times daily (6 mg total daily dosage) Chronic Diarrhea Adults The recommended initial dose is 4 mg (two capsules) followed by 2 mg (one capsule) after each unformed stool until diarrhea is controlled, after which the dosage of loperamide hydrochloride capsules should be reduced to meet individual requirements When the optimal daily dosage has been established, this amount may then be administered as a single dose or in divided doses. The average daily maintenance dosage in clinical trials was 4 to 8 mg (two to four capsules per day). The maximum daily dosage is 16 mg (eight capsules per day)

The Imodium dosage is as follows:

• Acute Diarrhea:
  • Adults and Pediatric Patients 13 Years and Older: 4 mg initially, followed by 2 mg after each unformed stool, with a maximum daily dose of 16 mg.
  • Pediatric Patients 2 to 12 Years of Age:
    • 2 to 5 years: 1 mg three times daily (3 mg total daily dosage)
    • 6 to 8 years: 2 mg twice daily (4 mg total daily dosage)
    • 8 to 12 years: 2 mg three times daily (6 mg total daily dosage)
• Chronic Diarrhea:
  • Adults: 4 mg initially, followed by 2 mg after each unformed stool, with a maximum daily dose of 16 mg and an average daily maintenance dosage of 4 to 8 mg. 2

From the Research

Imodium Dosage

• Imodium, also known as loperamide, is an antidiarrheal medication that works by decreasing peristalsis and fluid secretion, resulting in longer gastrointestinal transit time and increased absorption of fluids and electrolytes from the gastrointestinal tract 3.
• The dosage of Imodium is not explicitly stated in the provided studies, but its effectiveness in controlling diarrhea symptoms is well-documented 4, 5, 6, 3, 7.
• Loperamide is available without a prescription and is considered to be free of abuse potential 3.
• Common adverse reactions to loperamide include cramps and nausea 3.
• Loperamide is metabolized by the cytochrome P450 (CYP) system and is a substrate for the CYP3A4 isoenzyme, and concurrent administration with CYP3A4 inhibitors may elevate loperamide concentrations 3.
• In a randomized trial, octreotide was compared to loperamide in the treatment of fluorouracil-induced diarrhea, and octreotide was found to be more effective in controlling diarrhea and eliminating the need for replenishment of fluids and electrolytes 6.
• Loperamide is an effective treatment for patients with painless diarrhea, but it has no clinically significant analgesic activity and does not decrease the pain associated with some forms of irritable bowel syndrome and diarrhea 3.