From the Guidelines
For diarrhea and stomach pain, loperamide (Imodium) is generally the most effective over-the-counter treatment, as supported by the most recent and highest quality study 1. Adults should take 4mg initially, followed by 2mg after each loose stool, not exceeding 16mg daily for acute diarrhea, as recommended by the 2018 study 1. Bismuth subsalicylate (Pepto-Bismol) is an alternative, taken as two tablets or 30ml every 30-60 minutes as needed, up to 8 doses in 24 hours. These medications work by slowing intestinal motility and, in the case of bismuth subsalicylate, also providing anti-inflammatory and antibacterial effects. Some key points to consider when treating diarrhea and stomach pain include:
- Staying hydrated is crucial during diarrhea episodes, so drink plenty of fluids with electrolytes.
- For stomach pain, acetaminophen (Tylenol) is preferable to NSAIDs like ibuprofen, which may irritate the stomach.
- If symptoms persist beyond 2 days, are accompanied by high fever (over 101°F), severe abdominal pain, bloody stools, or signs of dehydration, seek medical attention immediately as these could indicate a more serious condition requiring prescription treatment. It's also important to note that while loperamide is effective for diarrhea, its use in irritable bowel syndrome with diarrhea (IBS-D) may have varying effects on global symptoms and abdominal pain, as seen in the 2021 study 1. However, the 2022 study 1 suggests using loperamide in patients with IBS-D, with a conditional recommendation and very low certainty. Overall, loperamide remains a recommended treatment for acute diarrhea, and its use should be guided by the most recent and highest quality evidence available 1.
From the FDA Drug Label
to take loperamide hydrochloride at the prescribed dosage Use of a higher than prescribed dosage is not recommended to contact their healthcare provider if they see blood in their stools, or if they develop a fever or abdominal distention
The best OTC treatment for a patient presenting with diarrhea and stomach pain is loperamide. Patients should be advised to take loperamide at the prescribed dosage and to contact their healthcare provider if they experience any worsening of symptoms, such as blood in their stools, fever, or abdominal distention 2.
From the Research
Treatment Options for Diarrhea and Stomach Pain
The best over-the-counter (OTC) treatment for a patient presenting with diarrhea and stomach pain can be determined by considering the following options:
- Loperamide: an effective therapy for various diarrheal syndromes, including acute, nonspecific diarrhea, traveler's diarrhea, and chemotherapy-related diarrhea 3, 4.
- Oral rehydration solutions: can help replace intestinal water and salt losses, but may not be optimized for treating diarrhea 5.
- Combination therapy: loperamide plus oral rehydration therapy may not offer significant benefits over loperamide alone in the treatment of traveler's diarrhea 6.
Mechanism of Action and Side Effects
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. Common side effects of loperamide include abdominal pain, distention, bloating, nausea, vomiting, and constipation 3, as well as cramps and nausea 4.
Considerations for Treatment
When evaluating a patient with diarrhea, a simplified 5-step approach can be applied to facilitate the evaluation and treatment of diarrhea 7. It is essential to consider the pathophysiologic mechanisms of diarrhea and the potential benefits and limitations of different treatment options. In this case, loperamide is considered an effective treatment for patients with painless diarrhea and is generally well tolerated at recommended nonprescription doses 3, 4. However, it may not decrease the pain associated with some forms of irritable bowel syndrome and diarrhea 4.