III. Contraindications

  1. Clostridioides difficile
  2. Dysentery (toxigenic Diarrhea)
  3. Child under age 2 years

IV. Mechanism

  1. Peripherally acting Opioid

V. Dosing: Acute Diarrhea

  1. Adult
    1. Initial: 4 mg orally for single first dose
    2. Titrate: 2 mg PO after each loose stool
    3. Maximum: 16 mg/day
  2. Child Age 9 to 12 year old (weight >30 kg)
    1. Give 2 mg orally three times daily
    2. Then 0.1 mg/kg orally after each loose stool
    3. Maximum: 6 mg/day in divided doses
  3. Child Age 6 to 8 years old (weight 21 to 30 kg)
    1. Give 2 mg orally twice daily
    2. Then 0.1 mg/kg orally after each loose stool
    3. Maximum: 4 mg/day in divided doses
  4. Child Age 2 to 5 years old (weight 13 to 20 kg)
    1. Give 1 mg orally three times daily on day 1
    2. Then 0.1 mg/kg orally after each loose stool
    3. Maximum: 3 mg/day in divided doses

VI. Dosing: Chronic Diarrhea or High Ileostomy Output

  1. Adults
    1. Start 4 mg
    2. Then 2 mg after each loose stool until Diarrhea is controlled
    3. Then taper to maintenance 4 to 8 mg/day in divided doses (or as single dose)
    4. Maximum: 16 mg/day
  2. Child (over age 2 years)
    1. Start 0.08 to 0.24 mg/kg/day orally divided 2 to 3 times daily
    2. Maximum: 2 mg/dose and 16 mg/day

VII. Safety

  1. Pregnancy Category C
  2. Safe in Lactation

VIII. Adverse Effects

X. References

  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 96

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Cost: Medications

loperamide (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
LOPERAMIDE 1 MG/7.5 ML SOLN Generic OTC $0.03 per ml
LOPERAMIDE 2 MG CAPSULE Generic $0.26 each
LOPERAMIDE-SIMETH 2-125 MG TAB Generic OTC $0.30 each