From the Guidelines
Loperamide can be taken with or without food, but it is recommended to take it on an empty stomach for faster relief, as there is no specific guidance in the provided evidence that suggests taking it with food is necessary or beneficial. For adults and children 12 years and older, the typical dose is 4 mg initially, followed by 2 mg after each loose stool, not exceeding 16 mg per day, as suggested by the guidelines for the prevention and treatment of travelers' diarrhea 1. When taking loperamide, it's essential to stay hydrated by drinking plenty of fluids and to discontinue use if symptoms persist for more than 2 days or if you develop a fever. Some key points to consider when taking loperamide include:
- The medication works by slowing down the movement of fluids through the intestines, which helps to reduce the frequency and volume of stools 1.
- It is crucial to counsel the traveler that if diarrhea worsens or is accompanied by moderate-severe or invasive symptoms, then antibiotics should be used 1.
- Loperamide has an FDA labeled indication for treatment of mild travelers' diarrhea, and the evidence supporting its use is strong, although the studies are somewhat dated 1.
- The starting dose and subsequent dosing should be spaced accordingly to avoid rebound constipation, with a recommended spacing of 1 to 2 hours for the therapeutic effect to take place 1.
From the Research
Administration of Loperamide
- The provided studies do not directly address whether Loperamide should be taken with food or on an empty stomach 2, 3, 4.
- However, a study on proton pump inhibitors suggests that taking medication before a meal can lead to better acid suppression compared to taking it without a meal 5.
- The mechanism of the antidiarrheal effect of Loperamide is related to its effect on intestinal motor function, rather than an acceleration of the rate of absorption by the intestine 6.
- There is no direct evidence to suggest that taking Loperamide with food or on an empty stomach affects its efficacy or safety 2, 3, 4, 6.
Pharmacology and Toxicity of Loperamide
- Loperamide is a nonprescription medication commonly used to treat diarrhea, with poor absorption and limited potential to cross the blood-brain barrier 2, 4.
- High doses of Loperamide can lead to cardiac toxicity, including QT-interval prolongation, widening of the QRS complex, and dysrhythmias such as torsades de pointes 2, 3, 4.