What is the recommended dose and frequency of Loperamide?

From the Guidelines

Loperamide is recommended to be started 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.

Key Points

• The initial dose of loperamide is 4 mg, as stated in the studies 1.
• The frequency of loperamide administration is 2 mg every 2-4 hours or after every unformed stool, as recommended in the studies 1.
• The maximum daily dose of loperamide is 16 mg, as stated in the studies 1.
• Loperamide can be used to slow small and large intestinal transit and reduce stool frequency and urgency in patients with irritable bowel syndrome (IBS), as mentioned in the study 1.

Clinical Considerations

• Loperamide should be used with caution in patients with severe diarrhea or those who are at risk of developing complications such as dehydration or electrolyte imbalances.
• Patients should be instructed to record the number of stools and report symptoms of life-threatening sequelae, such as fever or dizziness on standing, as recommended in the studies 1.
• Dietary modifications, such as eliminating lactose-containing products and high-osmolar dietary supplements, should be considered in patients with diarrhea, as recommended in the studies 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION 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 (see CONTRAINDICATIONS) Avoid loperamide hydrochloride capsule dosages higher than recommended in adult or pediatric patients 2 years of age and older due to the risk of serious cardiac adverse reactions (See WARNINGS, OVERDOSAGE). (1 capsule = 2 mg) Patients should receive appropriate fluid and electrolyte replacement as needed Acute Diarrhea Adults and Pediatric Patients 13 Years and Older: The recommended initial dose is 4 mg (two capsules) followed by 2 mg (one capsule) after each unformed stool. The maximum daily dose is 16 mg (eight capsules). Pediatric Patients 2 Years to 12 Years of Age: In pediatric patients 2 years to 5 years of age (20 kg or less), the non-prescription liquid formulation (Imodium A-D 1 mg/5 mL) should be used; for ages 6 to 12, either loperamide hydrochloride capsules or Imodium A-D liquid may be used For pediatric patients 2 to 12 years of age, the following schedule for capsules or liquid will usually fulfill initial dosage requirements: Recommended First Day Dosage Schedule Two to five years (13 to 20 kg): 1 mg three times daily (3 mg total daily dosage) Six to eight years (20 to 30 kg): 2 mg twice daily (4 mg total daily dosage) Eight to twelve years (greater than 30kg): 2 mg three times daily (6 mg total daily dosage) Chronic Diarrhea Adults The recommended initial dose is 4 mg (two capsules) followed by 2 mg (one capsule) after each unformed stool until diarrhea is controlled, after which the dosage of loperamide hydrochloride capsules should be reduced to meet individual requirements When the optimal daily dosage has been established, this amount may then be administered as a single dose or in divided doses. The average daily maintenance dosage in clinical trials was 4 to 8 mg (two to four capsules per day). The maximum daily dosage is 16 mg (eight capsules per day)

The recommended dose and frequency of Loperamide are as follows:

• Acute Diarrhea:
  • Adults and Pediatric Patients 13 Years and Older: 4 mg initially, followed by 2 mg after each unformed stool. The maximum daily dose is 16 mg.
  • Pediatric Patients 2 to 12 Years of Age:
    • 2 to 5 years: 1 mg three times daily (3 mg total daily dosage)
    • 6 to 8 years: 2 mg twice daily (4 mg total daily dosage)
    • 8 to 12 years: 2 mg three times daily (6 mg total daily dosage)
• Chronic Diarrhea:
  • Adults: 4 mg initially, followed by 2 mg after each unformed stool until diarrhea is controlled. The average daily maintenance dosage is 4 to 8 mg (two to four capsules per day), with a maximum daily dosage of 16 mg. 2

From the Research

Recommended Dose and Frequency of Loperamide

The recommended dose and frequency of loperamide vary depending on the condition being treated and the patient population.

• For acute diarrhea, a daily dose of 12 mg in either oral (4 mg t.d.s.) or suppository (6 mg b.d.) form has been studied 3.
• For chronic diarrhea, individually adapted doses (2--12 mg) of loperamide have been used, with a median treatment period of 543 days 4.
• In children older than 3 years with no/minimal dehydration, loperamide may be a useful adjunct to oral rehydration and early refeeding, with doses less than or equal to 0.25 mg/kg/d 5.
• A single nightly dose of loperamide has been found to be safe and efficient in patients with irritable bowel syndrome (IBS) 6.

Key Findings

• Loperamide has been shown to be effective in reducing stool frequency and improving stool consistency in patients with IBS 6 and chronic diarrhea 4.
• The drug has also been found to be safe and well-tolerated, with no evidence of tolerance or significant side effects 7, 4.
• In children, loperamide has been found to be effective in reducing the duration and severity of diarrhea, but its use is not recommended in children younger than 3 years due to the risk of serious adverse events 5.