LOPERAMIDE (Oral)

Some commonly used brand names are:

In the U.S.?

• Imodium
• Imodium A-D
• Imodium A-D Caplets
• Kaopectate II
• Maalox Anti-Diarrheal
• Pepto Diarrhea Control

In Canada?

• Apo-Loperamide
• Diarr-Eze
• Imodium
• Loperacap
• Nu-Loperamide
• PMS-Loperamide
• Rho-Loperamide

Generic name product may be available in the U.S. and Canada.

Category

• Antidiarrheal

Description

Loperamide (loe-PER-a-mide) is a medicine used along with other measuresto treat diarrhea. Loperamide helps stop diarrhea by slowing down the movementsof the intestines.

In the U.S., loperamide capsules are available only with your doctor'sprescription, while the liquid form and the tablet form are available withouta prescription. In Canada, all the dosage forms are available without a prescription.

Loperamide is available in the following dosage forms:

Oral
• Capsules (U.S. and Canada)
• Oral solution (U.S. and Canada)
• Tablets (U.S. and Canada)

Before Using This Medicine

If you are taking this medicinewithout a prescription, carefully read and follow any precautions on the label.For loperamide, the following should be considered:

Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to loperamide. Also tell your health care professional ifyou are allergic to any other substances, such as foods, preservatives, ordyes.

Pregnancy?Studies have not been done in humans. However, studiesin animals have not shown that loperamide causes cancer or birth defects orlessens the chances of becoming pregnant even when given in doses many timesthe human dose.

Breast-feeding?It is not known whether loperamide passes intobreast milk. Although most medicines pass into breast milk in small amounts,many of them may be used safely while breast-feeding. Mothers who are takingthis medicine and who wish to breast-feed should discuss this with their doctor.

Children?This medicine should not be used in children under6 years of age unless directed by a doctor. Children, especially very youngchildren, are very sensitive to the effects of loperamide. This may increasethe chance of side effects during treatment. Also, the fluid loss caused bydiarrhea may result in a serious health problem (dehydration). Loperamidemay hide the symptoms of dehydration. For these reasons, do not give medicinefor diarrhea to children without first checking with their doctor. If youhave any questions about this, check with your health care professional.

Older adults?The fluid loss caused by diarrhea may result in aserious health problem (dehydration). Loperamide may hide the symptoms ofdehydration. For this reason, elderly persons with diarrhea, in addition tousing medicine for diarrhea, must receive a sufficient amount of liquids toreplace the fluid lost by the body. If you have any questions about this,check with your health care professional.

Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. When you are takingloperamide, it is especially important that your health care professionalknow if you are taking any of the following:

• Antibiotics such as cephalosporins (e.g., Ceftin, Keflex), clindamycin(e.g., Cleocin), erythromycins (e.g., E.E.S., PCE), tetracyclines (e.g., Achromycin,Doryx)?These antibiotics may cause diarrhea; loperamide may make thediarrhea caused by antibiotics worse or make it last longer

• Narcotic pain medicine?There is a greater chance that severeconstipation may occur if loperamide is used together with narcotic pain medicine

Other medical problems?The presence of other medicalproblems may affect the use of loperamide. Make sure you tell your doctorif you have any other medical problems, especially:

• Colitis (severe)?A more serious problem of the colon may developif you use loperamide

• Dysentery?This condition may get worse; a different kind oftreatment may be needed

• Liver disease?The chance of severe central nervous system (CNS)side effects may be greater in patients with liver disease

Proper Use of This Medicine

Do not use loperamide to treat your diarrhea if you have a fever or if thereis blood or mucus in your stools. Contact your doctor.

For safe and effective use of this medicine:

• Follow your doctor's instructions if this medicinewas prescribed.
• Follow the manufacturer's package directions if you are treatingyourself.

Use a specially marked measuring spoon or other device to measure eachdose accurately. The average household teaspoon may not hold the right amountof liquid.

Importance of diet and fluid intake while treatingdiarrhea:

• In addition to using medicine for diarrhea, itis very important that you replace the fluid lost by the body and follow aproper diet. For the first 24 hours, you should eat gelatin, and drinkplenty of caffeine-free clear liquids, such as ginger ale, decaffeinated cola,decaffeinated tea, and broth. During the next 24 hours you may eat bland foods,such as cooked cereals, bread, crackers, and applesauce. Fruits, vegetables,fried or spicy foods, bran, candy, caffeine, and alcoholic beverages may makethe condition worse.
• If too much fluid has been lost by the body due to the diarrhea,a serious condition (dehydration) may develop. Check with your doctor as soonas possible if any of the following signs or symptoms of too much fluid lossoccur:
  • Decreased urination
  • Dizziness and lightheadedness
  • Dryness of mouth
  • Increased thirst
  • Wrinkled skin

Dosing?The dose of loperamide will be different fordifferent patients. Follow your doctor's orders or thedirections on the label. The following information includes only theaverage doses of loperamide. If your dose is different,do not change it unless your doctor tells you to do so.

• For diarrhea:
  • For oral dosage form (capsules):
    • Adults and teenagers?The usual dose is 4 milligrams (mg) (2capsules) after the first loose bowel movement, and 2 mg (1 capsule) aftereach loose bowel movement after the first dose has been taken. No more than16 mg (8 capsules) should be taken in any twenty-four-hour period.
    • Children 8 to 12 years of age?The usual dose is 2 mg (1 capsule)three times a day.
    • Children 6 to 8 years of age?The usual dose is 2 mg (1 capsule)two times a day.
    • Children up to 6 years of age?Use is not recommended unlessdirected by your doctor.
  • For oral dosage form (oral solution):
    • Adults and teenagers?The usual dose is 4 teaspoonfuls (4 mg)after the first loose bowel movement, and 2 teaspoonfuls (2 mg) after eachloose bowel movement after the first dose has been taken. No more than 8 teaspoonfuls(8 mg) should be taken in any twenty-four-hour period.
    • Children 9 to 11 years of age?The usual dose is 2 teaspoonfuls(2 mg) after the first loose bowel movement, and 1 teaspoonful (1 mg) aftereach loose bowel movement after the first dose has been taken. No more than6 teaspoonfuls (6 mg) should be taken in any twenty-four-hour period.
    • Children 6 to 8 years of age?The usual dose is 2 teaspoonfuls(2 mg) after the first loose bowel movement, and 1 teaspoonful (1 mg) aftereach loose bowel movement after the first dose has been taken. No more than4 teaspoonfuls (4 mg) should be taken in any twenty-four-hour period.
    • Children up to 6 years of age?Use is not recommended unlessdirected by your doctor.
  • For oral dosage form (tablets):
    • Adults and teenagers?The usual dose is 4 mg (2 tablets) afterthe first loose bowel movement, and 2 mg (1 tablet) after each loose bowelmovement after the first dose has been taken. No more than 8 mg (4 tablets)should be taken in any twenty-four-hour period.
    • Children 9 to 11 years of age?The usual dose is 2 mg (1 tablet)after the first loose bowel movement, and 1 mg (1/2 tablet) after eachloose bowel movement after the first dose has been taken. No more than 6 mg(3 tablets) should be taken in any twenty-four-hour period.
    • Children 6 to 8 years of age?The usual dose is 2 mg (1 tablet)after the first loose bowel movement, and 1 mg (1/2 tablet) after eachloose bowel movement after the first dose has been taken. No more than 4 mg(2 tablets) should be taken in any twenty-four-hour period.
    • Children up to 6 years of age?Use is not recommended unlessdirected by your doctor.

Missed dose?If you must take this medicine regularly and youmiss a dose, skip the missed dose and go back to your regular dosing schedule.Do not double doses.

Storage?To store this medicine:

• Keep out of the reach of children
• Store away from heat and direct light.
• Do not store the capsule or tablet form of this medicine in the bathroom,near the kitchen sink, or in other damp places. Heat or moisture may causethe medicine to break down.
• Keep the liquid form of this medicine from freezing.
• Do not keep outdated medicine or medicine no longer needed. Be surethat any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

Loperamideshould not be used for more than 2 days, unless directed by your doctor. Ifyou will be taking this medicine regularly for a long time, your doctor shouldcheck your progress at regular visits.

Check with your doctor if your diarrhea does not stopafter two days or if you develop a fever.

Side Effects of This Medicine

Along with its needed effects, a medicinemay cause some unwanted effects. When this medicine isused for short periods of time at low doses, side effects usually are rare.

However, check with yourdoctor immediately if any of the following side effects are severeand occur suddenly since they may be signs of a more severe and dangerousproblem with your bowels:

Rare

Bloating; constipation; loss of appetite; stomach pain (severe)with nausea and vomiting

Also, check with your doctor as soon as possibleif the following side effect occurs:

Rare

Skin rash

Other side effects may occur that usually donot need medical attention. These side effects may go away during treatmentas your body adjusts to the medicine. However, check with your doctor if anyof the following side effects continue or are bothersome:

Rare

Dizziness or drowsiness; dryness ofmouth

Other side effectsnot listed above may also occur in some patients. If you notice any othereffects, check with your doctor.