From the Guidelines
Loperamide should be started at an initial dose of 4 mg followed by 2 mg every 4 hours or after every unformed stool, not to exceed 16 mg/day. This recommendation is based on the most recent and highest quality study available, which suggests that this dosing regimen is effective in managing diarrhea in adult cancer patients 1. The same dosing regimen is also supported by another study, which provides further guidance on the prevention and treatment of acute radiation-induced diarrhea 1.
When considering the use of loperamide, it is essential to note that the medication works by slowing intestinal movement and increasing water absorption in the bowels, which helps reduce stool frequency and improve consistency. However, it is crucial to stay hydrated while taking loperamide, as diarrhea can cause significant fluid loss.
Some key points to consider when using loperamide include:
- Initial dose: 4 mg
- Subsequent doses: 2 mg every 4 hours or after every unformed stool
- Maximum daily dose: 16 mg
- Importance of staying hydrated
- Potential side effects: constipation, dizziness, and dry mouth
- Contraindications: bloody diarrhea, high fever, or diarrhea caused by certain bacterial infections
- Caution in patients with liver disease, as the medication is metabolized in the liver 1.
Overall, the recommended dose and frequency of loperamide are well-established, and the medication can be an effective treatment option for managing diarrhea in various patient populations.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Loperamide hydrochloride capsules are contraindicated in pediatric patients less than 2 years of age due to the risks of respiratory depression and serious cardiac adverse reactions (see CONTRAINDICATIONS) Avoid loperamide hydrochloride capsule dosages higher than recommended in adult or pediatric patients 2 years of age and older due to the risk of serious cardiac adverse reactions (See WARNINGS, OVERDOSAGE). (1 capsule = 2 mg) Patients should receive appropriate fluid and electrolyte replacement as needed 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. The maximum daily dose is 16 mg (eight capsules). 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) Chronic Diarrhea Adults The recommended initial dose is 4 mg (two capsules) followed by 2 mg (one capsule) after each unformed stool until diarrhea is controlled, after which the dosage of loperamide hydrochloride capsules should be reduced to meet individual requirements When the optimal daily dosage has been established, this amount may then be administered as a single dose or in divided doses. The average daily maintenance dosage in clinical trials was 4 to 8 mg (two to four capsules per day). The maximum daily dosage is 16 mg (eight capsules per day)
The recommended dose and frequency of Loperamide are as follows:
- Acute Diarrhea:
- Adults and Pediatric Patients 13 Years and Older: 4 mg initially, followed by 2 mg after each unformed stool. The maximum daily dose is 16 mg.
- Pediatric Patients 2 to 12 Years of Age:
- 2 to 5 years: 1 mg three times daily (3 mg total daily dosage)
- 6 to 8 years: 2 mg twice daily (4 mg total daily dosage)
- 8 to 12 years: 2 mg three times daily (6 mg total daily dosage)
- Chronic Diarrhea:
- Adults: 4 mg initially, followed by 2 mg after each unformed stool until diarrhea is controlled. The average daily maintenance dosage is 4 to 8 mg (two to four capsules per day), with a maximum daily dosage of 16 mg. 2
From the Research
Recommended Dose and Frequency of Loperamide
- The recommended initial dose of loperamide is 4 mg, followed by 2-4 mg every 6-8 hours as needed 3, 4, 5, 6.
- The total daily dose of loperamide can range from 12-16 mg per day, depending on the severity of diarrhea 3, 4.
- In some cases, a higher dose of loperamide may be effective in treating moderate diarrhea, but may not be as effective in treating more severe diarrhea 3.
- Loperamide can be taken for a duration of 3-5 days, or until diarrhea is resolved 4, 5, 6.
- The efficacy of loperamide can be enhanced when combined with other medications, such as sulfamethoxazole and trimethoprim or ofloxacin 5, 6.
Specific Dosage Regimens
- For traveler's diarrhea, a loading dose of 4 mg loperamide followed by 2 mg after each loose stool, not to exceed 16 mg per day, can be effective 5, 6.
- For acute diarrhea in adults, an initial dose of 1-2 mg loperamide oxide, followed by 1 tablet after each watery, loose, or pasty stool, can be effective 7.
- For chemotherapy-induced diarrhea, a dose of 4 mg loperamide every 8 hours, for a total daily dose of 16 mg, can be effective 3.