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Loperamide

    DEA Class; OTC

    Common Brand Names; Imodium, K-Pek II, NeoDiaral, Diaraid

    • Antidiarrheals

    Oral antidiarrheal agent related to opiates; actions more targeted to periphery; decreases peristalsis
    Used primarily for acute, nonspecific diarrhea, including nonspecific traveler’s diarrhea
    Due to serious and sometimes fatal cardiac events and respiratory depression, contraindicated in pediatric patients less than 2 years; recommended dosages should not be exceeded in other populations

    Indicated for the control of the symptoms of diarrhea, including acute nonspecific diarrhea, traveler’s diarrhea, chronic diarrhea, or to reduce ileostomy-associated diarrhea and output volume.

    For the adjunctive management of diarrhea-predominant irritable bowel syndrome.
    For the treatment of AIDS-associated enteropathy with no identifiable infectious cause.
    For management of late-onset irinotecan-induced diarrhea.

    Hypersensitivity, bloody diarrhea, high fever, infectious diarrhea, pseudomembranous colitis

    Patients in whom constipation must be avoided

    Abdominal pain without diarrhea

    Avoid use as primary therapy with acute dysentery (bloody stools and high fever, acute ulcerative colitis, bacterial enterocolitis [caused by Salmonella, Shigella, and Campylobacter), pseudomembranous colitis associated with antibiotic use)

    Age <2 years

    • Dizziness
    • Fatigue
    • Abdominal pain
    • Constipation
    • Nausea
    • Dry mouth
    • Angioedema
    • Bullous eruptions
    • Flatulence
    • Rash

    May cause drowsiness or dizziness, which may impair physical abilities to operate heavy machinery or tasks requiring mental alertness

    Hypersensitivity reactions reported, including anaphylaxis, rash, urticaria, and rare cases of Steven’s Johnson syndrome or toxic epidermal necrolysis

    Discontinue if no improvement seen within 48 hours in patients with acute diarrhea, symptoms worsen, or abdominal swelling or bulging develops

    Discontinue promptly if constipation, abdominal pain or distention, blood in stool, or ileus develops; do not use when peristalsis inhibition should be avoided (ie, due to potential for ileus, megacolon, or toxic megacolon)

    Discontinue therapy if symptoms of abdominal distention occur in patients with AIDS; cases of toxic megacolon reported with infectious colitis, resulting from viral or bacterial pathogens

    Use with caution in patients with hepatic impairment due to reduced first pass metabolism; monitor for signs of CNS toxicity

    Use of higher than recommended doses or abuse of loperamide can result in serious cardiac adverse events, including QT interval prolongation, Torsades de Pointes, or other ventricular arrhythmias, syncope, and cardiac arrest; in cases of abuse, individuals often use other drugs together with loperamide in attempts to increase its absorption and penetration across the blood-brain barrier, inhibit loperamide metabolism, and enhance its euphoric effects

    Dehydration, particularly in pediatric patients less than 6 years of age, may further influence variability of response to loperamide

    Avoid loperamide in combination with drugs or herbal products known to prolong QT interval, including Class 1A (e.g., quinidine, procainamide) or Class III (e.g., amiodarone, sotalol) antiarrhythmics, antipsychotics (e.g., chlorpromazine, haloperidol, thioridazine, ziprasidone), antibiotics (e.g., moxifloxacin), or any other drug known to prolong the QT interval (e.g., pentamidine, methadone)

    Pregnancy category: B

    Lactation: Not known if distributed in breast milk; use caution

    Adults

    8 mg/day PO for nonprescription use; 16 mg/day PO for prescription products; dosage may be titrated but should not exceed maximum recommendations per indication.

    Geriatric

    8 mg/day PO for nonprescription use; 16 mg/day PO for prescription products; dosage may be titrated but should not exceed maximum recommendations per indication.

    Adolescents

    8 mg/day PO for nonprescription use; 16 mg/day PO for prescription products; dosage may be titrated but should not exceed maximum recommendations per indication.

    Children

    12 years: 8 mg/day PO for nonprescription use; 16 mg/day PO for prescription products; dosage may be titrated but should not exceed maximum recommendations per indication.
    9 to 11 years: 6 mg/day PO.
    6 to 8 years: 4 mg/day PO.
    2 to 5 years: 3 mg/day PO.
    Less than 2 years: Contraindicated.

    Infants

    Contraindicated.

    Neonates

    Contraindicated.

    Loperamide 

    liquid

    • 1mg/5mL

    • 1mg/7.5mL

    suspension

    • 1mg/7.5mL

    tablet

    • 2mg

    capsule

    • 2mg

    tablet chewable

    • 2mg