From the Guidelines
The best prescription antidiarrheal medication is loperamide (Imodium), typically prescribed at 4mg initially followed by 2mg after each loose stool, not exceeding 16mg daily. This recommendation is based on the most recent and highest quality study available, which prioritizes morbidity, mortality, and quality of life as the outcome 1.
Key Considerations
- Loperamide works by slowing intestinal motility, allowing more water absorption and forming solid stools.
- Treatment duration should generally be limited to 48-72 hours for acute diarrhea.
- It's essential to maintain hydration while taking these medications by drinking plenty of fluids with electrolytes.
- These medications should not be used if diarrhea is accompanied by high fever or bloody stools, as these symptoms may indicate infection requiring different treatment.
- Underlying causes of diarrhea should be addressed, as antidiarrheals provide symptomatic relief but don't treat the root cause.
Special Considerations
- For severe cases, diphenoxylate-atropine (Lomotil) may be prescribed at 2.5-5mg four times daily until diarrhea is controlled.
- Antimotility drugs like loperamide should not be given to children <18 years of age with acute diarrhea, and should be avoided in suspected or proven cases where toxic megacolon may result in inflammatory diarrhea or diarrhea with fever 1.
- Antibiotics may be considered in certain cases, such as travelers' diarrhea, and should be used in combination with loperamide 1.
Important Reminders
- Medical evaluation is necessary before long-term antidiarrheal use, especially for chronic diarrhea.
- The use of antimotility, antinausea, or antiemetic agents should be considered once the patient is adequately hydrated, but their use is not a substitute for fluid and electrolyte therapy 1.
From the FDA Drug Label
Loperamide hydrochloride, 4-(p-chlorophenyl)-4-hydroxy-N,N-dimethyl-a,a-diphenyl-1-piperidinebutyramide monohydrochloride, is a synthetic antidiarrheal for oral use. The best antidiarrheal prescription is Loperamide (PO), as it is a synthetic antidiarrheal for oral use 2.
- Key points:
- Loperamide hydrochloride is available in 2 mg capsules for oral administration 2.
- It is used to treat diarrhea. Note: The provided information does not compare loperamide to other antidiarrheal medications.
From the Research
Antidiarrheal Prescription Options
- Loperamide is a commonly prescribed antidiarrheal medication, with studies showing its effectiveness in treating acute diarrhea 3, 4, 5.
- Loperamide has been compared to bismuth subsalicylate in several studies, with results indicating that loperamide is more effective in reducing the number of unformed bowel movements and providing faster relief 4, 5.
- Bismuth subsalicylate has also been shown to be effective in preventing and treating infectious diarrhea, including traveler's diarrhea 6.
- Racecadotril has been found to be effective in treating acute diarrhea in children, but its efficacy in adults is less convincing 7.
- Probiotics are indicated in children and for the prevention of antibiotics-induced diarrhea, but there is no evidence to support their use in the treatment of acute diarrhea in adults 7.
Key Findings
- Loperamide oxide 1 mg is a preferred treatment option for acute, non-dysenteric diarrhea due to its effectiveness and lower risk of constipation-like episodes 3.
- Loperamide is effective at a daily dosage limit of 8 mg (40 ml) for the treatment of acute nonspecific diarrhea and provides faster, more effective relief than bismuth subsalicylate 4.
- Bismuth subsalicylate has been shown to be beneficial for those at risk or affected by food and waterborne diarrheal disease, such as traveler's diarrhea, and may decrease the risk of inappropriate antibiotic utilization 6.