Mode of action
Activate opioid receptors in the gut wall, decreasing bowel motility and increasing fluid absorption.
Indications
Diarrhoea, usually short term treatment in adults, Intestinal stoma (to reduce frequency and fluidity of motions).
Combination with simethicone
Diarrhoea with associated gas-related abdominal discomfort, short term treatment in adults.
Contraindications
Intestinal obstruction, Children <2 years.
Specific considerations
Pregnancy: 1 or 2 doses safe to use; ADEC category B3.
Breastfeeding: 1 or 2 doses safe to use.
Severe ulcerative colitis: may precipitate toxic megacolon.
Hepatic impairment: avoid use in severe impairment; may precipitate hepatic encephalopathy.
Children: avoid use in children <6 years (contraindicated in children <2 years).
Adverse effects
Common: abdominal pain and bloating, nausea, vomiting, constipation.
Rare: paralytic ileus, dizziness, rash.
Dosage
Adult
Acute diarrhoea: Initially, 4 mg, then 2 mg after each loose bowel action.
Jordan National Drug Formulary
54
Intestinal stoma: 4–8 mg daily in 2–3 divided doses. Maximum dose 16 mg daily.
Short gut syndrome diarrhoea: Child, up to 1.25 mg/kg/day in 2–3 doses has been used.
Combination with simethicone
Initially, 2 tablets, then 1 tablet after each loose bowel action. Maximum 4 tablets daily
Practice points
do not use loperamide as an antidiarrhoeal in children, especially in those <6 years, except under specialist
supervision for diarrhoea associated with short gut syndrome
use as symptomatic treatment only in adults with acute diarrhoea
some people with chronic diarrhoea may require long term opioids; this should be a specialist decision.
Products
LOPERAMIDE CAPS/TABS 2 MG (AS HCL) (DIAPEN®, IMODIUM®, IMOTRIL®, LOPERIUM®,
VACONTIL®)