From the Guidelines
Loperamide should not be given concurrently with rifaximin as a standard practice, as it may interfere with the antibiotic's ability to eliminate the infectious organisms causing diarrhea. Rifaximin is typically used alone to treat traveler's diarrhea or irritable bowel syndrome with diarrhea (IBS-D) [ 1 ]. The standard dosage for traveler's diarrhea is 200 mg three times daily for 3 days. For IBS-D, it's usually 550 mg three times daily for 14 days. Some key points to consider:
- Loperamide, an anti-diarrheal agent, may potentially prolong the infection by reducing bowel motility and trapping pathogens in the intestines [ 1 ].
- In cases of certain bacterial infections (like E. coli), loperamide may increase the risk of complications [ 1 ].
- Rifaximin works by directly targeting and reducing the bacteria in the gut that cause diarrhea, while allowing the body to naturally eliminate the infection [ 1 ]. If symptoms are severe, healthcare providers may sometimes recommend using loperamide briefly for symptom relief, but this should be done under medical supervision and not as a standard practice with rifaximin treatment [ 1 ].
From the Research
Concurrent Administration of Loperamide and Rifaximin
- The concurrent administration of loperamide (Imodium) and rifaximin (Xifaxan) has been evaluated in the treatment of travelers' diarrhea 2.
- A study found that the combination of rifaximin and loperamide provided rapid symptomatic improvement and greater overall wellness compared to either agent alone 2.
- The combination therapy significantly reduced the median time until passage of the last unformed stool and the mean number of unformed stools passed during illness compared to loperamide alone 2.
- Rifaximin has been shown to be effective in the treatment of travelers' diarrhea, with a favorable efficacy, tolerability, and safety profile 3.
- Loperamide is an antimotility agent that provides rapid temporary relief of acute diarrhea, while rifaximin is an antibiotic that slowly cures the illness 2.
- The combination of an antimotility agent and an antibiotic may provide greater therapeutic benefit than either drug alone 2.
Safety and Efficacy
- The combination of rifaximin and loperamide was well tolerated with a low incidence of adverse events 2.
- Rifaximin has been shown to have a low potential for development of bacterial resistance and cytochrome P450-mediated drug-drug interactions 3.
- The tolerability profile of rifaximin is similar to that of placebo 3.