From the Guidelines
The recommended dosing for Imodium (loperamide) is 4 mg initially, followed by 2 mg after every loose stool, to a maximum of 16 mg/day. This dosing is based on the most recent and highest quality study available, which is the 2018 ESMO clinical practice guidelines for diarrhea in adult cancer patients 1.
Key Considerations
- The initial dose of 4 mg is typically followed by 2 mg after each loose stool, as needed.
- The maximum daily dose should not exceed 16 mg.
- It is essential to note that Imodium should be used with caution and under medical supervision in certain populations, such as children under 6 years.
Important Safety Information
- Imodium should not be used for bloody diarrhea, severe abdominal pain, or diarrhea caused by antibiotics.
- Treatment should not exceed 2 days without medical consultation, and if symptoms worsen or fever develops, seek medical attention immediately.
- Patients with liver disease should consult their doctor before use, as dosage adjustments may be necessary.
- Imodium should be taken with water, and alcohol should be avoided while using this medication.
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 dosing for Imodium is as follows:
- Acute Diarrhea:
- Adults and pediatric patients 13 years and older: 4 mg initially, followed by 2 mg after each unformed stool, with a maximum daily dose of 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, with a maximum daily dose of 16 mg.
- The average daily maintenance dosage is 4 to 8 mg (two to four capsules per day) 2
From the Research
Dosing for Imodium
- The dosing for Imodium, also known as loperamide, is not explicitly stated in the provided studies, but its efficacy and safety are discussed in various contexts 3, 4, 5, 6, 7.
- In the study published in 1978, it is mentioned that 4mg of loperamide has a longer duration of effect than 5mg of diphenoxylate in single dose studies 3.
- The 2008 study discusses the use of loperamide in various diarrheal syndromes, including acute, nonspecific diarrhea, and chemotherapy-related diarrhea, but does not specify the dosing 4.
- A 1990 study mentions that loperamide is a safe and effective antidiarrheal for the treatment of acute diarrhea, but does not provide specific dosing information 5.
- The 2025 study, although focused on the management of diarrhea in patients with stable ulcerative colitis, does not provide detailed information on the dosing of loperamide 6.
- An earlier study from 1976 discusses the use of loperamide in the treatment of chronic diarrhea, but also does not specify the dosing regimen 7.