It is an active ingredient of one of the most popular anti-diarrheal preparations available on the Polish market, called Stoperan. The preparation is available over the counter in pharmacies. However, before the patient reaches for loperamide, he should understand how it works and decide whether this drug is the most optimal option for him.

Loperamid - action

It is an anti-diarrheal drug belonging to the group of substances that slows down the motility of the intestines. After administration, the drug starts to work within an hour. Loperamide is an opioid and its action is limited to the gastrointestinal tract. After administration of loperamide, less than 1 percent of the dose reaches the circulating blood after it has passed through hepatic metabolism.

Loperamide binds to the opioid receptors of the intestinal wall cells, causing a strong reduction in intestinal peristalsis and an extension of the intestinal transit time. As the intestinal contents stay longer in the lumen of the large intestine, the absorption of water and electrolytes in this part of the gastrointestinal tract is increased.

It would seem that this solution is ideal in the event of acute diarrhea. Unfortunately, the effectiveness of loperamide treatment largely depends on the etiology of the existing diarrhea.In the case of a bacterial, viral or parasitic infection, administering loperamide is a big mistake . It causes the retention of toxins and microorganisms in the lumen of the intestine, exposing its mucosa to deepening inflammation and damage.

Remember that diarrhea is the body's natural reaction to a microorganism, and increased intestinal peristalsis is designed to remove toxins and microorganisms from the gastrointestinal tract.

Loperamide can be used for mild watery diarrhea without fever or blood in the stool. You can also administer loperamide to a patient with nervous diarrhea as a result of chronic stress (e.g. an exam or a difficult life situation).

Loperamide - indications

According to the safety data sheet, loperamide should be used in patients:

  • with acute and chronic diarrhea as symptomatic treatment,
  • with an ileal fistula to reduce the frequency and volume of stools.

In contrast, loperamideit is also administered outside official indications, e.g. in patients with the initial stage of fecal incontinence.

Loperamide - dosage

Loperamide can be given to adults and children over 6 years of age.

In the treatment of acute diarrhea, the starting dose is 2 loperamide tablets (4 mg each) for an adult patient and 1 tablet (2 mg) for children. Then 1 tablet (2 mg) is administered after each free stool.

For adults, the maximum dose is 8 tablets a day, that is 16 mg .In childrenthe daily maximum dose should be calculated on the basis of the child's weight:these are 3 tablets for every 20 kg of body weight .

Loperamide should be used for a maximum of 2 days. If there is no improvement, see a doctor.

If a patient is struggling with chronic diarrhea, consult a doctor about the way of taking loperamide and undergo possible diagnostics for more serious diseases of the gastrointestinal tract.

Loperamide - contraindications

  • You should not take the drug if the patient is sensitive to the active substance.
  • Loperamide should not be used in children under 6 years of age due to the lack of clinical trials in this age group regarding safety.
  • If you have blood in your stool and you have severe diarrhea with fever, do not give loperamide.
  • It is not recommended to use loperamide in an acute episode of ulcerative colitis.
  • Do not administer to patients with bacterial enterocolitis caused by pathogenic bacteria of the genera Salmonella, Shigella and Campylobacter.
  • In addition, it is forbidden to use loperamide in patients with pseudomembranous enteritis associated with the administration of broad-spectrum antibiotics.

Loperamide - warnings and precautions

Please note thattreatment with loperamide is only symptomatic . If it does not bring the expected effect, contact a specialist doctor who will commission a diagnosis and implement the appropriate causal treatment.

During diarrhea it is very important to replenish the patient's fluid . Young children are especially at risk of dehydration. There are ready-made products with electrolytes with reduced osmolality available on the market, which are recommended for patients with severe diarrhea. Their composition promotes the replenishment of electrolytes, and the reduced osmolality will reduce the risk of exacerbation of diarrhea.

The patient should consume easily digestible foods, juices and soups. As foodpermanent are recommended:

  • s alty crackers,
  • rice,
  • groats
  • or potatoes.

Avoid spicy foods in your diet and raw vegetables.

In a situationwhen loperamide is not used in accordance with the pharmacist's or doctor's recommendations(especially when intestinal motility should not be slowed down),may lead to serious complications . The above-mentioned include:

  • intestinal obstruction,
  • giant colon obstruction,
  • toxic enlargement of the colon.

The last mentioned may occur more often in people with AIDS treated with loperamide, therefore the therapy should be discontinued in these patients as soon as symptoms of abdominal distension appear.

Loperamide should be used with caution in people with liver problems or damaged liver . He succumbs to the so-called first-pass effect, which is directly related to hepatic metabolism. If the liver is not working properly, more of the drug could enter the systemic circulation and cause overdose or central nervous system side effects.

Overdosehas had cardiac episodes including QT prolongation and arrhythmias. There is even arisk of deathas a consequence of overdose, so do not take more than the dose recommended in this leaflet or determined by your doctor.

Loperamide should not be taken simultaneously with:

  • clarithromycin,
  • ketoconazole,
  • ranitidine,
  • cyclosporine,
  • verapamilem,
  • atorvastatin
  • and ritonavir.

These drugs affect the metabolism of loperamide.

Do not take loperamide simultaneously with drugs that stimulate the peristalsis of the gastrointestinal tract.

Loperamide - pregnancy and breastfeeding

Loperamide should not be used during pregnancy . Loperamide passes into breast milk, thereforeis not recommended for breastfeeding women .

Loperamide - side effects

The most common side effects include:

  • constipation,
  • flatulence,
  • headaches
  • and nausea.

You may experience symptoms such as drowsiness and dizziness, so keep this in mind when taking loperamide for the first time, driving a car or operating machinery.

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