Loperamide

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Administration

  • Type: Anti-diarrheal, opioid
  • Dosage Forms: 1mg, 2mg; 1/5 mL
  • Routes of Administration: PO
  • Common Trade Names: Imodium, Diamode, Imodium A-D, Imodium A-D EZ Chews, Imodium A-D New Formula, Kao-Paverin, Kaopectate 1-D

Adult Dosing

Acute Diarrhea

  • 2mg PO per dose
    • Start: 4mg PO x1, then 2mg PO after each loose stool; Max: 16mg/day

Chronic Diarrhea

  • 4-8mg/day PO divided QD-tid
    • Start: 4mg PO x1, then 2mg PO after each loose stool until maint. dose established; Max: 16mg/day

Pediatric Dosing

Acute diarrhea

  • 2-5 yo, 13-20 kg
    • Dose: 1mg PO x1 after each loose stool
      • Max: 3mg/day
      • Use OTC 1mg/5 sol or 1mg/7.5 mL susp
  • 6-8 yo, 20-30 kg
    • Dose: start 2mg PO x1, then 1mg PO after each loose stool
      • Max: 4mg/day
  • 8-11 yo, 30-40 kg
    • Dose: start 2mg PO x1, then 1mg PO after each loose stool
      • Max: 6mg/day
  • 12 yo and older
    • Dose: start 4mg PO x1, then 2mg PO after each loose stool
      • Max: 8mg/day

Chronic diarrhea

  • 0.08-0.24mg/kg/day PO divided bid-tid
    • Max: 2mg/dose

Special Populations

Renal Dosing

  • Adult:

Hepatic Dosing

  • Adult/Pediatric: Reduced first-pass metabolism
    • CNS toxicity

Contraindications

  • Allergy to class/drug

If given with:

  • potassium acid phosphate
  • potassium chloride
  • potassium citrate
  • potassium phosphate

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life: Half-life: 10.8h
  • Metabolism: liver; CYP450: 2C8, 3A4 substrate; Info: P-gp substrate; 40% systemic absorption
  • Excretion: feces 30%, urine <2%

Mechanism of Action

  • binds gut wall opioid receptor, inhibiting peristalsis; increases anal sphinctor tone

Comments

See Also

References