From the Guidelines
Treatment for loose bowels should start with oral rehydration solutions and loperamide at an initial dose of 4 mg followed by 2 mg every 2-4 hours or after every unformed stool, with a maximum daily dose of 16 mg, as recommended by the most recent guidelines 1. When managing loose bowels, it is essential to address the underlying cause while alleviating symptoms. The following steps can be taken:
- Oral rehydration solutions, such as Pedialyte or a homemade mixture of 1 liter water with 6 teaspoons sugar and 1/2 teaspoon salt, should be administered to prevent dehydration.
- Loperamide (Imodium) can be used at the recommended dose to reduce the frequency of bowel movements.
- Dietary modifications, such as following the BRAT diet (bananas, rice, applesauce, toast), can help manage symptoms.
- It is crucial to avoid dairy, caffeine, alcohol, and fatty or spicy foods temporarily. If symptoms persist beyond 2-3 days, are accompanied by fever over 102°F, severe abdominal pain, bloody stools, or signs of dehydration, medical attention should be sought immediately, as prescription antibiotics or further testing may be necessary 1. In cases where loperamide is not effective, other treatment options, such as octreotide or oral budesonide, may be considered, as outlined in the guidelines 1. The treatment approach should prioritize the patient's quality of life, morbidity, and mortality, and be guided by the most recent and highest-quality evidence available 1.
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. Treatment of diarrhea with loperamide hydrochloride is only symptomatic. The use of loperamide hydrochloride does not preclude the need for appropriate fluid and electrolyte therapy
Loperamide is used for the symptomatic relief of acute nonspecific diarrhea and chronic diarrhea in adults.
- It is also used for reducing the volume of discharge from ileostomies.
- Fluid and electrolyte therapy is important in patients with diarrhea, and the use of loperamide does not replace this need.
- Loperamide should not be used when inhibition of peristalsis is to be avoided, due to the possible risk of significant sequelae including ileus, megacolon and toxic megacolon 2, 2.
From the Research
Medical Treatment for Loose Bowel
- Loperamide is an effective therapy for various diarrheal syndromes, including acute, nonspecific diarrhea, traveler's diarrhea, and chemotherapy-related diarrhea 3.
- It is also effective for treating diarrhea in patients with painless diarrhea or diarrhea-predominant irritable bowel syndrome, and for increasing anal sphincter tone to improve fecal continence 3.
- Loperamide has been compared to bismuth subsalicylate for the treatment of acute travelers' diarrhea, and was found to be a safe and effective alternative, with fewer unformed stools passed by patients treated with loperamide 4.
- Current treatment options for irritable bowel syndrome diarrhea predominant (IBS-D) include loperamide, bile acid sequestrants, antispasmodics, tricyclic antidepressants, alosetron, eluxadoline, and rifaximin, with eluxadoline and rifaximin being newly FDA approved medications 5.
- A comparative study of loperamide hydrochloride and bismuth subsalicylate found that loperamide significantly reduced the average number of unformed bowel movements and provided faster, more effective relief than bismuth subsalicylate 6.
Treatment Options
- Loperamide: effective for various diarrheal syndromes, including acute, nonspecific diarrhea, traveler's diarrhea, and chemotherapy-related diarrhea 3, 4, 6.
- Bismuth subsalicylate: compared to loperamide, found to be less effective in reducing unformed bowel movements and providing relief 4, 6.
- Eluxadoline and rifaximin: newly FDA approved medications for the treatment of IBS-D, with potential benefits in treating diarrhea predominant irritable bowel syndrome 5.