Loper

Indications

Loperamide is used to relieve:

• short-term (acute) diarrhoea in adults and children aged 12 years and over;
• long-term diarrhoea from conditions such as irritable bowel syndrome or inflammatory bowel disease, under a doctor's supervision;
• frequent loose output in people with an ileostomy, as advised by a doctor.

It treats the symptom, not the cause. Replacing lost fluids with oral rehydration salts (ORS) remains the most important treatment for diarrhoea.

How It Works

Loperamide acts on opioid receptors in the wall of the gut. It slows the movement of the bowel, giving more time for water and salts to be absorbed, and tightens the muscle at the back passage. This makes stools firmer and less frequent. At normal doses it does not act on the brain.

Dosage and Administration

Acute diarrhoea, adults and children 12 years and over: 4 mg (2 capsules of 2 mg) at first, then 2 mg after each loose stool. Do not take more than 16 mg (8 capsules) in 24 hours; without a doctor's advice, 12 mg is a sensible limit. Stop once stools become normal or if there is no stool for 12 hours.

Do not use for more than 48 hours without seeing a doctor. Long-term diarrhoea: only as prescribed. Children under 12: only on a doctor's advice; never give to children under 2 years.

Drink plenty of fluids and use ORS to replace lost water and salts.

Interactions

• Medicines that raise Loperamide levels, such as Ritonavir, Itraconazole, Ketoconazole, Clarithromycin, Gemfibrozil and Quinidine, increase the risk of side effects including heart rhythm problems.
• Other medicines that affect heart rhythm (some antiarrhythmics, antipsychotics and antibiotics) add to this risk.
• Other medicines that slow the gut, such as opioid painkillers or anticholinergics, increase constipation.

Contraindications

• Children under 2 years
• Diarrhoea with blood in the stool or high fever (possible dysentery)
• Diarrhoea during or after antibiotic treatment (possible serious bowel infection)
• A flare-up of ulcerative colitis
• Constipation, a swollen tummy or when the bowel must not be slowed (such as bowel blockage)
• Allergy to Loperamide

Side Effects

Common: constipation, wind, nausea, headache and dizziness. Less often: tummy pain or bloating, dry mouth, tiredness and rash.

Stop and get medical help at once for a swollen or painful tummy, no bowel movement with bloating, blood in the stool, fever, fainting or a fast or irregular heartbeat, or a severe allergic or blistering skin reaction.

Pregnancy and Lactation

Avoid in pregnancy, especially the first 3 months, unless your doctor advises; ORS is the main treatment. Small amounts pass into breast milk; ask your doctor before using while breastfeeding.

Precautions and Warnings

• See a doctor if diarrhoea lasts more than 48 hours, or sooner if there is blood, high fever, severe tummy pain or signs of dehydration (very little urine, dizziness, dry mouth).
• Young children, older people and those who are weak are at greater risk of dehydration.
• Take extra care in liver disease.
• It may cause dizziness or tiredness; take care when driving.
• Never take more than the recommended dose: high doses can cause serious heart problems.

Overdose

Overdose can cause drowsiness, constipation, bowel blockage, slow breathing (more likely in children) and serious heart rhythm problems. Go to hospital at once. Naloxone may be used in hospital.

Therapeutic Class

Antidiarrhoeal (antimotility agent).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.