From the FDA Drug Label
DOSAGE AND ADMINISTRATION 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)
The recommended dosage of Loperamide for children is as follows:
- 2 to 5 years (13 to 20 kg): 1 mg three times daily (3 mg total daily dosage)
- 6 to 8 years (20 to 30 kg): 2 mg twice daily (4 mg total daily dosage)
- 8 to 12 years (greater than 30kg): 2 mg three times daily (6 mg total daily dosage) 1
From the Research
Loperamide is not recommended for children under 6 years of age and should be used with caution in older children, with the dosage typically being 1 mg (half a 2 mg tablet) up to three times daily for no more than two days for children 6-8 years old, and 2 mg up to four times daily for no more than two days for children 8-12 years. According to the most recent and highest quality study available, which is a systematic review and meta-analysis published in 2007 2, loperamide can be a useful adjunct to oral rehydration and early refeeding in children older than 3 years with no or minimal dehydration. However, in children younger than 3 years, malnourished, moderately or severely dehydrated, systemically ill, or with bloody diarrhea, the adverse events outweigh the benefits even at doses ≤0.25 mg/kg/d.
Key Considerations
- Oral rehydration therapy should be the primary treatment for childhood diarrhea, with loperamide used only as a short-term symptomatic treatment.
- Loperamide works by slowing intestinal motility and reducing fluid secretion, but this mechanism can potentially mask underlying conditions or delay the clearance of infectious agents, which is why its use is restricted in children.
- Parents should always consult a healthcare provider before giving loperamide to children, as dehydration from diarrhea can be dangerous in young patients.
Dosage Guidelines
- Children 6-8 years old: 1 mg (half a 2 mg tablet) up to three times daily for no more than two days.
- Children 8-12 years: 2 mg up to four times daily for no more than two days.
- Adolescents 12 and older: follow the adult dosage of 4 mg initially, followed by 2 mg after each loose stool, not exceeding 8 mg daily for over-the-counter use.
Important Safety Information
- Loperamide is not recommended for children under 6 years of age due to the risk of serious adverse events, such as ileus, lethargy, or death, as reported in the study published in 2007 2.
- The use of loperamide in children should be carefully considered, taking into account the potential benefits and risks, as well as the availability of alternative treatments, such as oral rehydration therapy and probiotics, as discussed in the study published in 2013 3.