From the Guidelines
Loperamide is recommended as the first-line treatment for acute, uncomplicated diarrhea in adults, with a standard dose of 4mg initially, followed by 2mg after each loose stool, not exceeding 16mg daily 1. The medication works by slowing down intestinal movement, allowing for more water absorption and firmer stools.
- Loperamide is effective for acute, uncomplicated diarrhea but should not be used if you have bloody stools, high fever, or a history of inflammatory bowel disease, as these may indicate a bacterial infection requiring different treatment.
- The medication works by binding to opioid receptors in the intestinal wall, reducing peristalsis and secretions, but has minimal central nervous system effects at recommended doses.
- Side effects may include constipation, abdominal discomfort, dizziness, and dry mouth.
- Importantly, taking higher than recommended doses can lead to serious heart problems or abuse potential, so always follow dosing instructions carefully.
- Loperamide can be used in patients with irritable bowel syndrome with diarrhea (IBS-D), as suggested by the AGA clinical practice guideline 1.
- The use of loperamide in cancer patients with diarrhea is also recommended, with a dose of 4mg initially, followed by 2mg every 2-4 hours or after every unformed stool, not exceeding 16mg daily 2, 3, 4.
From the FDA Drug Label
Loperamide hydrochloride capsules are indicated for the control and symptomatic relief of acute nonspecific diarrhea in patients 2 years of age and older and of chronic diarrhea in adults associated with inflammatory bowel disease. Loperamide hydrochloride capsules are also indicated for reducing the volume of discharge from ileostomies. The use of Loperamide is for:
- Control and symptomatic relief of acute nonspecific diarrhea in patients 2 years of age and older
- Control and symptomatic relief of chronic diarrhea in adults associated with inflammatory bowel disease
- Reducing the volume of discharge from ileostomies 5
From the Research
Uses of Loperamide
- Loperamide is an established treatment for acute diarrhoea with only rare adverse reactions 6
- It is used for symptomatic control of acute non-specific diarrhoea and chronic diarrhoea 7
- Loperamide provides more rapid control of symptoms than diphenoxylate in acute diarrhoea 7
- It is probably superior to diphenoxylate in providing symptomatic control of chronic diarrhoea 7
- Loperamide is effective for the "gut-directed" symptom of diarrhea in patients with painless diarrhea or diarrhea-predominant irritable bowel syndrome 8
- It is used to treat diarrhea in numerous settings of inflammatory bowel disease 8
- Loperamide can be used as monotherapy or as an adjunct to antibiotic treatment in immunocompetent adults with acute infectious traveller's diarrhoea or community-acquired diarrhoea without severe comorbidities 9
Mechanism of Action
- Loperamide works by decreasing peristalsis and fluid secretion, resulting in longer gastrointestinal transit time and increased absorption of fluids and electrolytes from the gastrointestinal tract 10
- It has a longer duration of action than diphenoxylate 7, 10
- Loperamide has minimal central nervous system effects due to its low oral absorption and inability to cross the blood-brain barrier 10
Safety and Tolerance
- Loperamide is generally well tolerated at recommended nonprescription doses 8
- Common adverse reactions to loperamide include cramps and nausea 10
- Loperamide is considered to be free of abuse potential 10
- International guidelines now often support the use of loperamide for the treatment of infectious diarrhoea without dysentery 9