From the Guidelines
Loperamide is contraindicated in children under 2 years of age, and its use is not recommended in suspected or proven cases of toxic megacolon, inflammatory diarrhea, or diarrhea with fever.
Contraindications for Loperamide
- Children under 2 years of age due to the risk of adverse central and peripheral side-effects, such as ileus, likely caused by immature hepatic function and blood-brain barrier or inadvertent overdose 1
- Suspected or proven cases of toxic megacolon, as loperamide may worsen the condition by slowing gut motility 1
- Inflammatory diarrhea or diarrhea with fever, as loperamide may mask symptoms and potentially lead to worse outcomes 1
Special Considerations
- Loperamide may be used with caution in children between 2 and 11 years of age with acute diarrhea, as it has been shown to be beneficial without causing severe adverse events 1
- In adults, loperamide is generally safe and effective for the treatment of acute diarrhea, including traveler's diarrhea, but its use should be avoided in cases of dysentery or suspected bacterial infection 1
From the FDA Drug Label
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 patients with a known hypersensitivity to loperamide hydrochloride or to any of the excipients. patients with abdominal pain in the absence of diarrhea. patients with acute dysentery, which is characterized by blood in stools and high fever. patients with acute ulcerative colitis. patients with bacterial enterocolitis caused by invasive organisms including Salmonella, Shigella, and Campylobacter. patients with pseudomembranous colitis (e.g., Clostridium difficle) associated with the use of broad-spectrum antibiotics.
The contraindications for Loperamide are:
- Pediatric patients less than 2 years of age due to the risks of respiratory depression and serious cardiac adverse reactions
- Hypersensitivity to loperamide hydrochloride or any of the excipients
- Abdominal pain in the absence of diarrhea
- Acute dysentery
- Acute ulcerative colitis
- Bacterial enterocolitis caused by invasive organisms
- Pseudomembranous colitis associated with the use of broad-spectrum antibiotics 2
From the Research
Contraindications for Loperamide
The provided studies do not explicitly list contraindications for loperamide. However, we can infer some potential contraindications based on the information provided:
- Children younger than 3 years, as serious adverse events were reported in this age group 3
- Malnourished children, as adverse events may outweigh benefits 3
- Children with moderate or severe dehydration, as loperamide may not be suitable for this population 3
- Systemically ill children, as loperamide may not be suitable for this population 3
- Children with bloody diarrhea, as loperamide may not be suitable for this population 3
- Patients with dysentery, as caution is advised when using loperamide in this population 4
- Patients with severe comorbidities, as loperamide may not be suitable for this population 4
Special Considerations
Some special considerations should be taken into account when using loperamide:
- Concurrent administration with CYP3A4 inhibitors may elevate loperamide concentrations 5
- Loperamide is not recommended for patients with abdominal cramping, as it may exacerbate this condition 6
- Loperamide is not suitable for patients who require analgesia, as it has no clinically significant analgesic activity 5