From the FDA Drug Label
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. Elderly No formal pharmacokinetic studies were conducted in elderly subjects However, there were no major differences reported in the drug disposition in elderly patients with diarrhea relative to young patients. No dose adjustment is required for the elderly.
The patient is 90 years old and has watery diarrhea. Loperamide can be given to the patient. The recommended initial dose is 4 mg (two capsules) followed by 2 mg (one capsule) after each unformed stool.
- No dose adjustment is required for the elderly.
- The maximum daily dose is 16 mg (eight capsules). 1
From the Research
For a 90-year-old patient with watery diarrhea who is taking multiple medications, the recommended treatment should begin with oral rehydration therapy using electrolyte solutions to prevent dehydration, which is particularly dangerous in elderly patients. Temporarily stopping Jardiance (empagliflozin) should be considered as this SGLT2 inhibitor can sometimes cause or worsen diarrhea, as noted in general clinical practice 2, 3. The patient should continue Eliquis (apixaban) without interruption due to the high risk of thrombotic events if anticoagulation is stopped.
Treatment Options
- Loperamide 2mg can be used after each loose stool (maximum 8mg daily) for symptomatic relief, but should be limited to 2-3 days in this elderly patient, as supported by studies on the efficacy and safety of loperamide in treating chronic diarrhea 3, 4.
- If diarrhea persists beyond 48-72 hours, medical evaluation is essential to rule out Clostridioides difficile infection or other serious causes.
- Blood work to check electrolytes and kidney function is important as diarrhea can affect the efficacy and safety of medications like Eliquis and Amlodipine.
- The patient should maintain adequate fluid intake of at least 2-3 liters daily unless contraindicated by heart failure. This approach addresses both symptom management and the potential medication interactions that are particularly concerning in elderly patients with multiple comorbidities, aligning with the principles outlined in studies on managing chronic diarrhea 2, 3.