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Imodium (loperamide hydrochloride) is an anti-diarrheal drug. Imodium works by reducing the muscular contractions of the intestine, which reduces the speed at which waste moves through the gut. This in turn lets the body absorb more water and electrolytes from the gut contents back into the body, which means firmer and less frequent bowel movements.

Common uses

Imodium (loperamide hydrochloride) is indicated for the control and symptomatic relief of acute nonspecific diarrhea and of chronic diarrhea associated with inflammatory bowel disease. Imodium is also indicated for reducing the volume of discharge from ileostomies.

Before using

Your doctor need to know if you have any of these conditions:
•a black or bloody stool
•bacterial food poisoning
•colitis or mucus in your stool
•currently taking an antibiotic medication for an infection
•diarrhea for more than 2 days
•fever
•liver disease
•severe abdominal pain, swelling or bulging
•an unusual or allergic reaction to loperamide, other medicines, foods, dyes, or preservatives
•pregnant or trying to get pregnant
•breast-feeding

Directions

Drink extra water while you are taking this medication to keep from getting dehydrated. It may take up to 48 hours of taking loperamide before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 10 days of treatment. Loperamide can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.


Cautions

Do not use this medication if you are allergic to loperamide, or if you have:
• stools that are bloody, black, or tarry; or
• if you have diarrhea that is caused by taking an antibiotic.
Before taking loperamide, tell your doctor if you are allergic to any drugs, or if you have:
• a fever;
• mucus in your stools;
• a history of liver disease; or
• if you are taking an antibiotic.
If you have any of these conditions, you may not be able to use loperamide, or you may need a dosage adjustment or special tests during treatment.
FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether loperamide passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give this medicine to a child younger than 2 years old without the advice of a doctor.

Possible side effects

Imodium is contraindicated in patients with a known hypersensitivity to loperamide hydrochloride or to any of the excipients.
Imodium is contraindicated in patients with abdominal pain in the absence of diarrhea.
Imodium is not recommended in infants below 24 months of age.
Imodium should not be used as the primary therapy:
- in patients with acute dysentery, which is characterized by blood in stools and high fever,
- in patients with acute ulcerative colitis,
- in patients with bacterial enterocolitis caused by invasive organisms including Salmonella, Shigella, and Campylobacter,
- in patients with pseudomembranous colitis associated with the use of broad- spectrum antibiotics.

If you take too much

Seek emergency medical attention if you think you have used too much of this medicine.
Symptoms of a loperamide overdose may include dizziness, drowsiness, urinating less than usual, severe stomach cramps or bloating, and vomiting.

Additional information

Loperamide can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink.
Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use loperamide to stop the diarrhea unless your doctor has told you to.

Drug interactions

Nonclinical data have shown that loperamide is a P-glycoprotein substrate. Concomitant administration of loperamide (16 mg single dose) with a 600 mg single dose of either quinidine, or ritonavir, both of which are P-glycoprotein inhibitors, resulted in a 2- to 3- fold increase in loperamide plasma levels. Due to the potential for enhanced central effects when loperamide is coadministered with quinidine and with ritonavir, caution should be exercised when loperamide is administered at the recommended dosages (2 mg, up to 16 mg maximum daily dose) with P-glycoprotein inhibitors.
When a single 16-mg dose of loperamide is coadministered with a 600 mg single dose of saquinavir, loperamide decreased saquinavir exposure by 54%, which may be of clinical relevance due to reduction of therapeutic efficacy of saquinavir. The effect of saquinavir on loperamide is of less clinical significance. Therefore, when loperamide is given with saquinavir, the therapeutic efficacy of saquinavir should be closely monitored.