Loperamide hydrochloride
Loperamide hydrochloride (Imodium)
Loperamide hydrochloride
(loh- PER-ah-myd)
Pregnancy Category: B Apo-Loperamide Diarr-Eze Imodium Imodium A-D Caplets Kaopectate II Caplets Loperacap Maalox Anti-Diarrheal Caplets Novo-Loperamide Pepto Diarrhea Control PMS-Loperamide Hydrochloride (Imodium is Rx, all others are OTC)

Classification: Antidiarrheal agent, systemic

Action/Kinetics: Slows intestinal motility by acting on the nerve endings and/or intramural ganglia embedded in the intestinal wall. The prolonged retention of the feces in the intestine results in reducing the volume of the stools, increasing viscosity, and decreasing fluid and electrolyte loss. Reportedly more effective than diphenoxylate. Time to peak effect, capsules: 5 hr; PO solution: 2.5 hr. t 1/2: 9.1-14.4 hr. Twenty-five percent excreted unchanged in the feces.

Uses: Rx: Symptomatic relief of acute nonspecific diarrhea and of chronic diarrhea associated with inflammatory bowel disease. Decrease the volume of discharge from ileostomies.
OTC: Control symptoms of diarrhea, including traveler's diarrhea. Investigational: With trimethoprim-sulfamethoxazole to treat traveler's diarrhea.

Contraindications: In clients in whom constipation should be avoided. OTC if body temperature is over 101°F (38°C) and in presence of bloody diarrhea. Use in acute diarrhea associated with organisms that penetrate the intestinal mucosa, such as E. coli, Salmonella and Shigella.

Special Concerns: Safe use in children under 2 years of age and during lactation has not been established. Fluid and electrolyte depletion may occur in clients with diarrhea. Children less than 3 years of age are more sensitive to the narcotic effects of loperamide.

Side Effects: GI: Abdominal pain, distention, or discomfort. Constipation, dry mouth, N&V;, epigastric distress. Toxic megacolon in clients with acute colitis. CNS: Drowsiness, dizziness, fatigue. Other: Allergic skin rashes.

Overdose Management: Symptoms: Constipation, CNS depression, GI irritation. Treatment: Give activated charcoal (it will reduce absorption up to ninefold). If vomiting has not occurred, perform gastric lavage followed by activated charcoal, 100 g, through a gastric tube. Give naloxone for respiratory depression.

How Supplied: Capsule: 2 mg; Liquid: 1 mg/5 mL; Tablet: 2 mg

Dosage
?Rx Capsules, Liquid Acute diarrhea.
Adults, initial: 4 mg, followed by 2 mg after each unformed stool, up to maximum of 16 mg/day. Pediatric: D ay 1 doses: 8-12 years: 2 mg t.i.d.; 6-8 years: 2 mg b.i.d.; 2-5 years: 1 mg t.i.d. using only the liquid. After day 1: 1 mg/10 kg after a loose stool (total daily dosage should not exceed day 1 recommended doses).
Chronic diarrhea.
Adults: 4-8 mg/day as a single or divided dose. Dosage not established for chronic diarrhea in children.
?OTC Oral Solution, Tablets Acute diarrhea.
Adults: 4 mg after the first loose bowel movement followed by 2 mg after each subsequent bowel movement to a maximum of 8 mg/day for no more than 2 days. Pediatric, 9-11 years: 2 mg after the first loose bowel movement followed by 1 mg after each subsequent loose bowel movement, not to exceed 6 mg/day for no more than 2 days. Pediatric, 6-8 years: 1 mg after the first bowel movement followed by 1 mg after each subsequent loose bowel movement, not to exceed 4 mg/day for no more than 2 days.