From the Guidelines
You should take an over-the-counter medication like loperamide (Imodium) at a dose of 4mg initially, followed by 2mg after each loose stool, not exceeding 8mg per day, as it is the most effective treatment for acute diarrhea in adults, according to the guidelines for adults on self-medication for the treatment of acute diarrhoea 1. To manage your diarrhea, you can follow these steps:
- Stay hydrated by drinking clear fluids such as water, diluted fruit juices, or oral rehydration solutions like Pedialyte to replace lost electrolytes.
- Avoid dairy products, caffeine, alcohol, and greasy or spicy foods while your digestive system recovers.
- Eat bland foods like bananas, rice, applesauce, and toast (the BRAT diet) until symptoms improve. It's also important to note that probiotic preparations may be offered to reduce the symptom severity and duration in immunocompetent adults and children with infectious or antimicrobial-associated diarrhea, as recommended by the 2017 infectious diseases society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1. However, if your diarrhea is severe, lasts more than 2-3 days, contains blood, or is accompanied by fever over 101°F or severe abdominal pain, you should see a healthcare provider immediately, as medical intervention is recommended for the management of acute diarrhoea in such cases 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). INDICATIONS AND USAGE 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.
To control diarrhea, the recommended initial dose of loperamide is 4 mg (two capsules) followed by 2 mg (one capsule) after each unformed stool. The maximum daily dose is 16 mg (eight capsules) 2. Loperamide is 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 2.
- Key points:
- Take 4 mg (two capsules) initially
- Take 2 mg (one capsule) after each unformed stool
- Maximum daily dose: 16 mg (eight capsules)
- Receive appropriate fluid and electrolyte replacement as needed
- Use with caution in patients with hepatic impairment 2
From the Research
Diarrhea Treatment Options
- Loperamide is an effective therapy for various diarrheal syndromes, including acute, nonspecific diarrhea, and is generally well tolerated at recommended nonprescription doses 3, 4.
- Probiotics, such as Lactobacillus rhamnosus GG and Saccharomyces boulardii, have been shown to be effective in preventing and treating diarrhea, particularly in cases of acute gastroenteritis and antibiotic-associated diarrhea 5, 6, 7.
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 4.
- Probiotics, on the other hand, have been found to reduce the duration of diarrhea and improve gastrointestinal quality of life by promoting a healthy gut microbiome 5, 6, 7.
Safety and Efficacy
- Loperamide is considered safe and effective for the treatment of diarrhea, with common side effects related to bowel motility, such as abdominal pain, distention, bloating, nausea, vomiting, and constipation 3, 4.
- Probiotics have also been found to be safe and well-tolerated, with no significant adverse effects reported in clinical trials 6, 7.