Loperamide

Loperamide Brand Names

Anti-Diarrheal | Imodium A-D | Imodium A-D EZ Chews | K-Pek II

What is Loperamide

Loperamide is an oral antidiarrheal agent that is chemically related to opioids. It is indicated for the control and relief of acute, nonspecific diarrhea as well as chronic diarrhea associated with inflammatory bowel disease.

Loperamide is also indicated for reducing the volume of discharge from ileostomies.

While the drug is still available for prescription use, loperamide is also widely used for nonprescription (OTC) use for the acute treatment of traveler’s diarrhea and is an option recommended by the American Gastroenterology Association for the management of diarrhea predominant irritable bowel syndrome.

Efficacy in the treatment of diarrhea is comparable to that of diphenoxylate, and tolerance to the antidiarrheal effect has not been observed. Although loperamide is chemically related to opioids, the drug does not exhibit analgesic or opiate like effects, nor does it appear to produce physical dependence.

However, intentional misuse or abuse of high loperamide doses has been observed in patients attempting to self-treat opioid withdrawal or achieve a euphoric feeling.

These intentional high doses, along with elevated loperamide concentrations resulting from drug interactions, have been associated with serious cardiac events, including hospitalization, torsade de pointes, and sudden cardiac death.

Due to the severity of these adverse events, the FDA has limited the number of doses available in nonprescription packaging and issued a boxed warning regarding the need to follow recommended dosages to avoid serious cardiac events. Patients should be counseled not to exceed recommended daily doses.

Indications

  1. AIDS-associated enteropathy
  2. diarrhea
  3. ileostomy-associated diarrhea
  4. irinotecan-induced diarrhea
  5. irritable bowel syndrome
  6. traveler’s diarrhea

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 acute nonspecific diarrhea, including traveler’s diarrhea

Side Effects

  1. abdominal pain
  2. anaphylactic shock
  3. anaphylactoid reactions
  4. angioedema
  5. bullous rash
  6. cardiac arrest
  7. constipation
  8. dizziness
  9. drowsiness
  10. dyspepsia
  11. erythema multiforme
  12. fatigue
  13. flatulence
  14. headache
  15. ileus
  16. nausea
  17. pruritus
  18. QT prolongation
  19. respiratory depression
  20. Stevens-Johnson syndrome
  21. syncope
  22. torsade de pointes
  23. toxic epidermal necrolysis
  24. toxic megacolon
  25. urinary retention
  26. urticaria
  27. ventricular tachycardia
  28. vomiting
  29. xerostomia

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • abdominal pain
  • acquired immunodeficiency syndrome (AIDS)
  • apheresis
  • AV block
  • bradycardia
  • breast-feeding
  • cardiac arrest
  • cardiac arrhythmias
  • cardiomyopathy
  • celiac disease
  • children
  • constipation
  • driving or operating machinery
  • dysentery
  • females
  • fever
  • gastroenteritis
  • geriatric
  • heart failure
  • hepatic disease
  • human immunodeficiency virus (HIV) infection
  • hyperparathyroidism
  • hypocalcemia
  • hypokalemia
  • hypomagnesemia
  • hypothermia
  • hypothyroidism
  • ileus
  • infants
  • infection
  • long QT syndrome
  • myocardial infarction
  • neonates
  • pheochromocytoma
  • pregnancy
  • pseudomembranous colitis
  • QT prolongation
  • respiratory depression
  • rheumatoid arthritis
  • sickle cell disease
  • sleep deprivation
  • stroke
  • substance abuse
  • syncope
  • systemic lupus erythematosus (SLE)
  • torsade de pointes
  • toxic megacolon
  • ulcerative colitis

Interactions

  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Codeine
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  • grapefruit juice
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
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