From the Guidelines
Loperamide is not suitable for a 2-year-old child.
Reasons for this decision
- According to the guidelines for the diagnosis and management of infectious diarrhea, antimotility drugs (eg, loperamide) should not be given to children <18 years of age with acute diarrhea 1.
- The use of loperamide in children under 2 years of age is contraindicated due to the risk of rare adverse central and peripheral (ileus) side-effects, probably due to immature hepatic function and blood-brain barrier, or inadvertent overdose 1.
- Deaths have been reported in 0.54% of children given loperamide, and all of these events occurred in children <3 years old 1.
- The evidence suggests that loperamide may be beneficial in adults and children over 2 years of age with acute diarrhea, but its use in younger children is not recommended due to the potential risks.
Key points to consider
- Oral rehydration is the primary treatment for acute diarrhea in children.
- Antimotility agents, such as loperamide, should be avoided in children under 18 years of age with acute diarrhea.
- Loperamide may be considered in immunocompetent adults with acute watery diarrhea, but its use should be avoided in suspected or proven cases of toxic megacolon or inflammatory diarrhea 1.
From the FDA Drug Label
Loperamide hydrochloride is contraindicated in pediatric patients less than 2 years of age due to the risks of respiratory depression and serious cardiac adverse reactions 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
Loperamide is not suitable for a 2-year-old child due to the risk of respiratory depression and serious cardiac adverse reactions. The FDA drug label explicitly states that loperamide is contraindicated in pediatric patients less than 2 years of age 2 2.
From the Research
Loperamide Suitability for 2-Year-Old Child
- The use of loperamide in children under 3 years old is generally discouraged due to concerns over safety and efficacy, as reported in a systematic review and meta-analysis 3.
- A study found that loperamide may be useful as an adjunct to oral rehydration and early refeeding in children over 3 years old with no or minimal dehydration, but its use in younger children is not recommended 3.
- Another study concluded that the use of loperamide is not recommended in the treatment of infants and young children with acute diarrhea due to potential harmful side effects 4.
- However, a multicenter randomized controlled trial found that loperamide was well tolerated and significantly shortened the duration and severity of symptoms of acute nonspecific diarrhea in children 2 through 11 years of age 5.
- A comparative trial of cholestyramine and loperamide for acute diarrhea in infants treated as outpatients found that the use of loperamide did not appear justified 6.
- A case report described a 2-year-old girl who developed paralytic ileus after being prescribed loperamide for acute gastroenteritis, highlighting the potential risks of using this medication in young children 7.