From the Guidelines
For acute diarrhea in adults, the recommended dosage of loperamide is 4 mg (two 2 mg capsules or tablets) initially, followed by 2 mg after each loose stool, not exceeding 16 mg per day, as supported by the most recent guidelines 1. The usage of loperamide for treating acute diarrhea is recommended for mild cases, where it can help reduce stool frequency and improve consistency by slowing intestinal movement and increasing water absorption. Key points to consider when using loperamide include:
- Starting dose: 4 mg (two 2 mg capsules or tablets) initially
- Subsequent doses: 2 mg after each loose stool
- Maximum daily dose: 16 mg per day
- Duration of use: Symptoms should improve within 48 hours; if not, discontinue use and consult a healthcare provider
- Contraindications: High fever, blood in stool, or diarrhea caused by certain bacterial infections like E. coli, Salmonella, or Shigella
- Hydration: Stay hydrated while taking loperamide, as diarrhea can cause significant fluid loss
- Extended use: Not recommended beyond two days without medical supervision It's essential to note that loperamide is not a substitute for medical treatment in cases of severe diarrhea or when accompanied by other concerning symptoms, and its use should be guided by the most recent and highest quality evidence, such as the guidelines provided by the Journal of Travel Medicine 1.
From the FDA Drug Label
Dose: Dogs and cats: 0.1 mg/2.204 Lb. equivalent to 1 drop per 2.204 Lb. every 8 hours. The FDA drug label does not answer the question.
From the Research
Recommended Dosage and Usage of Loperamide
The recommended dosage and usage of Loperamide for treating acute diarrhea vary depending on the study.
- A study published in 1994 2 found that two tablets of loperamide oxide (1 mg or 2 mg) were taken initially, and then one tablet was taken after each watery, loose, or pasty stool to a maximum of eight tablets per day.
- Another study from 1978 3 suggested that loperamide provides more rapid control of symptoms than diphenoxylate when given in a flexible dosage according to unformed bowel movements, and in single dose studies, 4mg loperamide has a much longer duration of effect than 5mg diphenoxylate.
- A 2018 study 4 mentioned that high-dose loperamide is often used for the acute management of chemotherapy-induced diarrhea, with a maximum daily dosing of up to 24 mg.
Efficacy and Safety of Loperamide
The efficacy and safety of loperamide have been evaluated in several studies.
- A study from 1999 5 found that a loperamide-simethicone combination product provides faster and more complete relief of acute nonspecific diarrhea and associated gas-related abdominal discomfort than either of its components or placebo.
- Another study from 1999 6 demonstrated that oral rehydration therapy plus loperamide versus loperamide alone in the treatment of traveler's diarrhea showed equivalent clinical responses with regard to diminishment of diarrhea or subjective findings.
- The 2018 study 4 noted that the incidence of serious cardiac events associated with loperamide remains low, and the risk of uncontrolled complications from chemotherapy-induced diarrhea is likely greater than the rare cardiac risk associated with the chronic misuse of much higher doses of loperamide.
Usage Guidelines
Based on the studies, the following usage guidelines can be inferred:
- Loperamide can be taken initially in a dose of 1-2 mg, followed by 1 mg after each unformed stool, up to a maximum of 8 tablets per day 2.
- For chemotherapy-induced diarrhea, a maximum daily dosing of up to 24 mg can be used 4.
- Loperamide can be combined with simethicone for faster and more complete relief of acute nonspecific diarrhea and associated gas-related abdominal discomfort 5.
- Oral rehydration therapy can be used in addition to loperamide for the treatment of traveler's diarrhea, although it may not offer additional benefits 6.