Is loperamide (antidiarrheal medication) safe to use during breastfeeding?

From the Guidelines

Loperamide is generally considered safe to use during breastfeeding, with minimal amounts passing into breast milk, posing a very low risk to the nursing infant. The medication works by slowing intestinal motility and reducing water secretion in the bowel, which helps control diarrhea without significant systemic absorption, as noted in the 2017 infectious diseases society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1. This limited absorption explains why very little medication reaches breast milk. The standard adult dose of loperamide (Imodium) is 4 mg initially, followed by 2 mg after each loose stool, not exceeding 16 mg per day. For breastfeeding mothers, no dosage adjustment is necessary.

• Key points to consider:
  • Short-term use for acute diarrhea is particularly safe
  • Use the lowest effective dose for the shortest duration needed
  • If diarrhea persists beyond two days or is accompanied by fever or blood in stool, breastfeeding mothers should consult their healthcare provider as these symptoms may indicate a condition requiring different treatment
  • The American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases, published in 2020, provides recommendations on medication use during breastfeeding, but does not specifically address loperamide 1
  • However, the guideline emphasizes the importance of maintaining disease control with lactation-compatible medications and reviewing individualized risks and benefits with each patient
  • As loperamide is not explicitly mentioned in the guideline, its safety during breastfeeding is inferred from its pharmacological properties and the general principles outlined in the guideline.

From the Research

Loperamide and Breastfeeding

• Loperamide is considered compatible with breastfeeding by the American Academy of Pediatrics (AAP) 2
• The AAP lists loperamide as one of the medications that can be used by breastfeeding women, along with other gastrointestinal medications such as cimetidine, atropine, and senna 2
• However, there is limited information on the transfer of loperamide into breast milk, and its effects on nursing infants are not well studied 2, 3
• A study on the use of loperamide in infants and young children found that it may cause potentially harmful side-effects in a small number of patients, but this study did not specifically address breastfeeding women 4
• Another study found that loperamide is not recommended for the treatment of infants and young children with acute diarrhea, but again, this study did not address breastfeeding women 4
• In general, breastfeeding women can use most medications safely, but it is always best to consult with a healthcare provider before taking any medication, including loperamide 3
• Loperamide has been shown to be effective in reducing the duration and severity of diarrhea in adults, but its safety and efficacy in breastfeeding women have not been extensively studied 5, 6