Loperamide
Place in Therapy
Place in Therapy
Loperamide is an antisecretory drug which aids in the treatment of diarrhea.(1) Loperamide is used for moderate to severe diarrhea and can be used in children over the age of 2.(1,2) It is often recommended over other agents due to the uncertainty of other medications in terms of efficacy, delay in the onset of action or potential side effects that may arise.(1) Currently loperamide can be safely used in adults; however, administration of loperamide in children under the age of 12 should be held until a physician is consulted.(2) There have been many studies in using loperamide in children under the age of 12 to determine efficacy and the dose required to aid in the treatment of diarrhea.(3) Nonetheless, it is still advised to consult a physician before administering loperamide in a young child.(2) For patients that are pregnant it would be advised to take loperamide on the advice of a physician as the safe use of loperamide during pregnancy has not been established.(4) Furthermore, loperamide is not recommended for patients who are breast feeding and should be avoided.(4)
When loperamide has been compared to attapulgite for moderately severe acute diarrhea, loperamide was shown to be more effective, including the non-prescription dose of loperamide.(5) Loperamide and simethicone combination products were also studied against the products alone.(6) It was noted that the combination product of loperamide-simethicone had quicker relief of diarrhea and decreased the time of the last unformed stool.(6) It should also be noted, that the loperamide treatment arm had patients which had a faster reduction in loose bowel movements compared to the simethicone alone treatment arm.(6) In both cases, loperamide is quite effective in treating diarrheal symptoms.(6) Loperamide has been studied in children between the ages of 2-11 as a liquid formulation for acute nonspecific diarrhea.(7) Patients that were assigned to the treatment arm (liquid loperamide), experienced quicker relief of diarrheal symptoms.(7) However, there is still an ongoing debate about using loperamide in children. Currently the World Health Organization and American Academy of Pediatrics recommends the use of oral rehydration therapy over the use of medications.(7,8)
References:
1. Wingate D, Phillips SF, Lewis SJ, Malageladas JR, Speelman P, Steffen R, et al. Guidelines for adults on self-medication for the treatment of acute diarrhea. Aliment Pharmacol Ther. 2001;15:773-782.
2. Forrester A. Gastrointestinal conditions – diarrhea. In: Repchinsky C, ed. Patient Self Care. Ottawa: Canadian Pharmacists Association; 2010:281-297.
3. Li ST, Grossman DC, Cummings P. Loperamide therapy for acute diarrhea in children: systematic review and meta-analysis. Plos Med. 2007;4(3):495-505. doi:10.1371/journal.pmed.0040098
4. e-Therapeutics. Imodium caplets, quick-dissolve, calming liquid, liquid gels(CPhA Monograph). https://www.e-
therapeutics.ca/cps.showMonograph.action?simpleQuery=Imodium%20Caplets/Imodium%20Quick-
Dissolve/Imodium%20Calming%20Liquid/Imodium%20Liqui-
Gels&simpleIndex=brand_generic&simpleMonographId=m260800&simpleMonographDin=02183862&simpleMonographN
pn=&simpleMonographCphaId=&simpleMonographManufacturer=McNeil%20Consumer%20Healthcare&brandExactMat
ch=true&newSearch=true#. Updated 2014. Accessed June 20, 2014.
5. DuPont HL, Ericsson CD, DuPont MW, Luna AC, Mathewson JJ. A randomized, open-label comparison of nonprescription loperamide and attapulgite in the symptomatic treatment of acute diarrhea. Am J Med. 1990; 88:20-23.
6. Kaplan MA, Prior MJ, Ash RR, McKonly KI, Helzner EC, Nelson EB. Loperamide-simethicone vs. loperamide alone, simethicone alone and placebo in the treatment of acute diarrhea with gas-related abdominal discomfort. Arch Fam Med. 1999;8:243-248.
7. Kaplan MA, Prior MJ, McKonly KI, DuPont HL, Temple AR, Nelson EB. A multicenter randomized controlled trial of a liquid loperamide product versus placebo in the treatment of acute diarrhea in children. Clin Pediatr. 1999;38:579-591.
8. World Health Organization. World Gastroenterology Organisation practice guideline: Acute diarrhea. World Health Organization. http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/01_acute_diarrhea.pdf. Published March 2008. Accessed May 21 2014.
Loperamide is an antisecretory drug which aids in the treatment of diarrhea.(1) Loperamide is used for moderate to severe diarrhea and can be used in children over the age of 2.(1,2) It is often recommended over other agents due to the uncertainty of other medications in terms of efficacy, delay in the onset of action or potential side effects that may arise.(1) Currently loperamide can be safely used in adults; however, administration of loperamide in children under the age of 12 should be held until a physician is consulted.(2) There have been many studies in using loperamide in children under the age of 12 to determine efficacy and the dose required to aid in the treatment of diarrhea.(3) Nonetheless, it is still advised to consult a physician before administering loperamide in a young child.(2) For patients that are pregnant it would be advised to take loperamide on the advice of a physician as the safe use of loperamide during pregnancy has not been established.(4) Furthermore, loperamide is not recommended for patients who are breast feeding and should be avoided.(4)
When loperamide has been compared to attapulgite for moderately severe acute diarrhea, loperamide was shown to be more effective, including the non-prescription dose of loperamide.(5) Loperamide and simethicone combination products were also studied against the products alone.(6) It was noted that the combination product of loperamide-simethicone had quicker relief of diarrhea and decreased the time of the last unformed stool.(6) It should also be noted, that the loperamide treatment arm had patients which had a faster reduction in loose bowel movements compared to the simethicone alone treatment arm.(6) In both cases, loperamide is quite effective in treating diarrheal symptoms.(6) Loperamide has been studied in children between the ages of 2-11 as a liquid formulation for acute nonspecific diarrhea.(7) Patients that were assigned to the treatment arm (liquid loperamide), experienced quicker relief of diarrheal symptoms.(7) However, there is still an ongoing debate about using loperamide in children. Currently the World Health Organization and American Academy of Pediatrics recommends the use of oral rehydration therapy over the use of medications.(7,8)
References:
1. Wingate D, Phillips SF, Lewis SJ, Malageladas JR, Speelman P, Steffen R, et al. Guidelines for adults on self-medication for the treatment of acute diarrhea. Aliment Pharmacol Ther. 2001;15:773-782.
2. Forrester A. Gastrointestinal conditions – diarrhea. In: Repchinsky C, ed. Patient Self Care. Ottawa: Canadian Pharmacists Association; 2010:281-297.
3. Li ST, Grossman DC, Cummings P. Loperamide therapy for acute diarrhea in children: systematic review and meta-analysis. Plos Med. 2007;4(3):495-505. doi:10.1371/journal.pmed.0040098
4. e-Therapeutics. Imodium caplets, quick-dissolve, calming liquid, liquid gels(CPhA Monograph). https://www.e-
therapeutics.ca/cps.showMonograph.action?simpleQuery=Imodium%20Caplets/Imodium%20Quick-
Dissolve/Imodium%20Calming%20Liquid/Imodium%20Liqui-
Gels&simpleIndex=brand_generic&simpleMonographId=m260800&simpleMonographDin=02183862&simpleMonographN
pn=&simpleMonographCphaId=&simpleMonographManufacturer=McNeil%20Consumer%20Healthcare&brandExactMat
ch=true&newSearch=true#. Updated 2014. Accessed June 20, 2014.
5. DuPont HL, Ericsson CD, DuPont MW, Luna AC, Mathewson JJ. A randomized, open-label comparison of nonprescription loperamide and attapulgite in the symptomatic treatment of acute diarrhea. Am J Med. 1990; 88:20-23.
6. Kaplan MA, Prior MJ, Ash RR, McKonly KI, Helzner EC, Nelson EB. Loperamide-simethicone vs. loperamide alone, simethicone alone and placebo in the treatment of acute diarrhea with gas-related abdominal discomfort. Arch Fam Med. 1999;8:243-248.
7. Kaplan MA, Prior MJ, McKonly KI, DuPont HL, Temple AR, Nelson EB. A multicenter randomized controlled trial of a liquid loperamide product versus placebo in the treatment of acute diarrhea in children. Clin Pediatr. 1999;38:579-591.
8. World Health Organization. World Gastroenterology Organisation practice guideline: Acute diarrhea. World Health Organization. http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/01_acute_diarrhea.pdf. Published March 2008. Accessed May 21 2014.