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loperamide
generic
Black Box Warnings .
Torsades de Pointes and Sudden Death
torsades de pointes, cardiac arrest, and death reported w/ higher than recommended doses; avoid use of higher than recommended loperamide doses due to risk of serious cardiac adverse rxns; contraindicated in pts <2 yo
Adult Dosing .
Dosage forms: CAP: 2 mg; TAB: 2 mg; SUSP: 1 mg per 7.5 mL; SOL: 1 mg per 5 mL
diarrhea, acute
- [2 mg PO per dose]
- Start: 4 mg PO x1, then 2 mg PO after each loose stool; Max: 16 mg/day
diarrhea, chronic
- [4-8 mg/day PO divided qd-qid]
- Start: 4 mg PO x1, then 2 mg PO after each loose stool until maint. dose established; Max: 16 mg/day
high-output ileostomy
- [4-8 mg/day PO divided qd-qid]
- Max: 16 mg/day
short bowel syndrome (off-label)
- [2-4 mg PO tid-qid]
- Info: for pts w/ high-output ostomy; refer to ESPEN guidelines
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: CAP: 2 mg; TAB: 2 mg; SUSP: 1 mg per 7.5 mL; SOL: 1 mg per 5 mL
diarrhea, acute
- [2-5 yo, 13-20 kg]
- Dose: 1 mg PO x1 after each loose stool; Max: 3 mg/day
- [6-8 yo, 20-30 kg]
- Dose: start 2 mg PO x1, then 1 mg PO after each loose stool; Max: 4 mg/day
- [8-11 yo, 30-40 kg]
- Dose: start 2 mg PO x1, then 1 mg PO after each loose stool; Max: 6 mg/day
- [12 yo and older]
- Dose: start 4 mg PO x1, then 2 mg PO after each loose stool; Max: 8 mg/day
diarrhea, chronic
- [0.08-0.24 mg/kg/day PO divided bid-tid]
- Max: 2 mg/dose
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- abdominal pain w/o diarrhea
- diarrhea, bloody
- diarrhea, infectious
- pseudomembranous colitis
- ulcerative colitis, acute
- pts <2 yo
- caution: peds pts
- caution: hepatic impairment
- caution: HIV dz, advanced
- caution: diarrhea >48h
- caution: environmental temperature, high
- caution: electrolyte abnormalities
- caution: long QT syndrome, congenital
- caution: QT prolongation
- caution: QT prolongation family hx
- caution: torsades de pointes hx
- caution: ventricular arrhythmia
- caution: bradycardia
- caution: MI, recent
- caution: CHF
Drug Interactions .
Overview
loperamide
antidiarrheal
- CYP2C8 substrate
- CYP3A4 substrate
- P-gp substrate
- alters gallbladder contraction/motility
- decreases gastrointestinal motility
- prolongs QT interval (conditional)
Contraindicated
- pimozide
- potassium chloride
- potassium citrate
- thioridazine
- ziprasidone
Avoid/Use Alternative
- adagrasib
- amiodarone
- anagrelide
- apalutamide
- apomorphine
- arsenic trioxide
- artemether/lumefantrine
- asenapine
- azithromycin
- bedaquiline
- cabozantinib
- ceritinib
- chloroquine
- cisapride
- citalopram
- clarithromycin
- clofazimine
- clozapine
- crizotinib
- degarelix
- desflurane
- desipramine
- dexmedetomidine
- dexmedetomidine injection
- disopyramide
- dofetilide
- domperidone
- donepezil
- dronedarone
- droperidol
- eluxadoline
- encorafenib
- ephedra
- epirubicin
- eribulin
- erythromycin
- fexinidazole
- flecainide
- fluorouracil
- gilteritinib
- glasdegib
- goserelin
- haloperidol
- histrelin
- hydroxychloroquine
- hydroxyzine
- ibutilide
- inotuzumab ozogamicin
- isoflurane
- ivosidenib
- lefamulin
- leuprolide
- levofloxacin
- levoketoconazole
- lofexidine
- lonafarnib
- macimorelin
- methadone
- mobocertinib
- moxifloxacin
- nilotinib
- oliceridine
- ondansetron
- osimertinib
- pacritinib
- paliperidone
- palonosetron
- pasireotide
- pentamidine
- pramlintide
- procainamide
- propafenone
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- quinine
- quizartinib
- revefenacin inhaled
- ribociclib
- romidepsin
- rucaparib
- saquinavir
- selpercatinib
- sevoflurane
- sotalol
- telavancin
- tetrabenazine
- ticagrelor
- toremifene
- tramadol
- triclabendazole
- trifluridine
- triptorelin
- vandetanib
- vemurafenib
Monitor/Modify Tx
- atazanavir
- belumosudil
- cannabidiol
- chloramphenicol
- cimetidine
- clomipramine
- cobicistat
- cyclosporine
- gemfibrozil
- glecaprevir
- hyoscyamine
- idelalisib
- itraconazole
- ketoconazole
- lopinavir/ritonavir
- mifepristone
- nefazodone
- nelfinavir
- panobinostat
- pibrentasvir
- posaconazole
- ritonavir
- sincalide
- tucatinib
- verapamil
- voriconazole
- voxilaprevir
Caution Advised
- aclidinium inhaled
- alfentanil
- alosetron
- amantadine
- amitriptyline
- amoxapine
- atropine
- barium
- belladonna alkaloids
- benztropine
- brompheniramine
- buprenorphine
- butorphanol
- carbinoxamine
- chlorpheniramine
- chlorpromazine
- clemastine
- clidinium
- codeine
- cyclobenzaprine
- cyproheptadine
- darifenacin
- dexchlorpheniramine
- dicyclomine
- difenoxin
- dihydrocodeine
- dimenhydrinate
- diphenhydramine
- diphenoxylate
- doxepin
- doxepin topical
- doxylamine
- erenumab
- fentanyl
- fesoterodine
- flavoxate
- fluphenazine
- glycopyrrolate
- glycopyrrolate inhaled
- glycopyrronium topical
- homatropine
- hydrocodone
- hydromorphone
- imipramine
- ipratropium inhaled
- levorphanol
- loxapine
- meclizine
- meperidine
- methscopolamine
- metoclopramide
- mexiletine
- mirtazapine
- molindone
- morphine
- nalbuphine
- nortriptyline
- olanzapine
- orphenadrine
- oxybutynin
- oxycodone
- oxymorphone
- pentazocine
- perphenazine
- pheniramine
- potassium acid phosphate
- potassium gluconate
- potassium phosphate
- prochlorperazine
- promethazine
- protriptyline
- pyrilamine
- quetiapine
- remifentanil
- scopolamine
- solifenacin
- sufentanil
- tapentadol
- thiothixene
- tolterodine
- trifluoperazine
- trihexyphenidyl
- trimipramine
- triprolidine
- trospium
Adverse Reactions .
Serious Reactions
- toxic megacolon
- paralytic ileus
- hypersensitivity rxn
- angioedema
- anaphylactoid rxn
- anaphylaxis
- toxic epidermal necrolysis
- Stevens-Johnson syndrome
- erythema multiforme
- urinary retention
- heat stroke
- syncope
- ventricular tachycardia
- abuse potential
Common Reactions
- constipation
- nausea
- abdominal cramps
- dizziness
- drowsiness
Safety/Monitoring .
Monitoring Parameters
s/sx CNS toxicity if hepatic impairment
Look/Sound-Alike Drug Names
loperamide confused with: furosemide; Lomotil; LORazepam
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; possible risk of teratogenicity based on conflicting human data
Lactation
Clinical Summary
may use while breastfeeding; no human data available, though risk of infant harm and adverse effects on milk production not expected based on minimal maternal systemic absorption
Formulary .
No Formulary Selected
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