Alternate Name(s):
Imodium®
Classification:
Anti-Diarrheal
Original Date:
October 2022
Indications:
- Short Bowel Syndrome (dumping)
Administration:
- PO
- Available a 0.2 mg/mL oral solution, or a 2 mg tablet
- Tablets may be split and crushed before administration.
Dosage:
- Short Bowel Syndrome (dumping): 0.2-1 mg/kg/day, divided q8h. Lowest effective dose should be used.
- Maximum mg/dose for newborns is not clearly established. A 2 mg/dose max is suggested for infants > 2 months and children for dumping due to intestinal failure/short gut syndrome, however, the potential for adverse effects increase with escalating doses (see Side Effects section)
- No data available on the safety/dosing for premature infants.
Side Effects:
- Oral absorption is typically poor, therefore the most common side effects are gastrointestinal (constipation, cramping)
- Other rare side effects (may be related to higher than recommended doses, but some could occur with therapeutic dosing): drowsiness, skin rash, urinary retention, CNS/respiratory depression, paralytic ileus, arrythmia
Parameters to Monitor:
- Stool output
- Signs of CNS or respiratory depression
Notes:
- Use with caution in hepatic impairment
- Not recommended for routine use to treat diarrhea in infants. Avoid use in patients experiencing bloody stools or severe dehydration.
References:
- Litovitz T, Clancy C, Korberly B, Temple AR, Mann KV. Surveillance of loperamide ingestions: an analysis of 216 poison center reports. J Toxicol Clin Toxicol. 1997;35(1):11-9.
- Motala C, Hill ID, Mann MD, Bowie MD. Effect of loperamide on stool output and duration of acute infectious diarrhea in infants. J Pediatr. 1990 Sep;117(3):467-71.
- Li ST, Grossman DC, Cummings P. Loperamide therapy for acute diarrhea in children: systematic review and meta-analysis. PLoS Med. 2007 Mar 27;4(3):e98.
- Lexi-Comp Online Database, Accessed Sept 2022
- The Hospital for Sick Children 2020 Drug Handbook and Formulary.