Loperamide: Difference between revisions
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==Administration== | ==Administration== | ||
*Type: | *Type: Anti-diarrheal, [[opioid]] | ||
*Dosage Forms: | *Dosage Forms: 1mg, 2mg; 1/5 mL | ||
*Routes of Administration: | *Routes of Administration: PO | ||
*Common Trade Names: Imodium | *Common Trade Names: Imodium, Diamode, Imodium A-D, Imodium A-D EZ Chews, Imodium A-D New Formula, Kao-Paverin, Kaopectate 1-D | ||
==Adult Dosing== | ==Adult Dosing== | ||
===Acute Diarrhea=== | |||
* | *2mg PO per dose | ||
**Start: 4mg PO x1, then 2mg PO after each loose stool; Max: 16mg/day | |||
===Chronic Diarrhea=== | |||
*4-8mg/day PO divided QD-tid | |||
**Start: 4mg PO x1, then 2mg PO after each loose stool until maint. dose established; Max: 16mg/day | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
===Acute diarrhea=== | |||
*2-5 yo, 13-20 kg | |||
**Dose: 1mg PO x1 after each loose stool | |||
***Max: 3mg/day | |||
***Use OTC 1mg/5 sol or 1mg/7.5 mL susp | |||
*6-8 yo, 20-30 kg | |||
**Dose: start 2mg PO x1, then 1mg PO after each loose stool | |||
***Max: 4mg/day | |||
*8-11 yo, 30-40 kg | |||
**Dose: start 2mg PO x1, then 1mg PO after each loose stool | |||
***Max: 6mg/day | |||
*12 yo and older | |||
**Dose: start 4mg PO x1, then 2mg PO after each loose stool | |||
***Max: 8mg/day | |||
===Chronic diarrhea=== | |||
*0.08-0.24mg/kg/day PO divided bid-tid | |||
**Max: 2mg/dose | |||
==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B | ||
*[[Lactation risk categories|Lactation risk]]: Probably safe | *[[Lactation risk categories|Lactation risk]]: Probably safe | ||
===Renal Dosing=== | ===Renal Dosing=== | ||
*Adult: | *Adult: | ||
===Hepatic Dosing=== | ===Hepatic Dosing=== | ||
*Adult/Pediatric: Reduced first-pass metabolism | *Adult/Pediatric: Reduced first-pass metabolism | ||
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==Contraindications== | ==Contraindications== | ||
*Allergy to class/drug | *Allergy to class/drug | ||
If given with: | |||
*potassium acid phosphate | |||
*potassium chloride | |||
*potassium citrate | |||
*potassium phosphate | |||
==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
*toxic megacolon | *[[Loperamide toxicity]] | ||
*[[toxic megacolon]] | |||
*paralytic ileus | *paralytic ileus | ||
*angioedema | *[[angioedema]] | ||
*anaphylaxis/anaphylactoid | *[[anaphylaxis]]/anaphylactoid reaction | ||
*toxic epidermal necrolysis | *[[toxic epidermal necrolysis]] | ||
*Stevens-Johnson syndrome | *[[Stevens-Johnson syndrome]] | ||
*erythema multiforme | *[[erythema multiforme]] | ||
*urinary retention | *[[urinary retention]] | ||
*heat stroke | *[[heat stroke]] | ||
===Common=== | ===Common=== | ||
*constipation | *[[constipation]] | ||
*nausea | *[[nausea]] | ||
*abdominal cramps | *[[abdominal cramps]] | ||
*dizziness | *[[dizziness]] | ||
==Pharmacology== | ==Pharmacology== | ||
| Line 69: | Line 79: | ||
==Mechanism of Action== | ==Mechanism of Action== | ||
binds gut wall opioid receptor, inhibiting peristalsis; increases anal sphinctor tone | *binds gut wall opioid receptor, inhibiting peristalsis; increases anal sphinctor tone | ||
==Comments== | ==Comments== | ||
==See Also== | ==See Also== | ||
*[[Loperamide toxicity]] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pharmacology]] [[Category:GI]] | ||
*[https://online.epocrates.com/drugs/181310/Imodium/Monograph Epocrates: Loperamide] | *[https://online.epocrates.com/drugs/181310/Imodium/Monograph Epocrates: Loperamide] | ||
Latest revision as of 22:57, 22 September 2019
Administration
- Type: Anti-diarrheal, opioid
- Dosage Forms: 1mg, 2mg; 1/5 mL
- Routes of Administration: PO
- Common Trade Names: Imodium, Diamode, Imodium A-D, Imodium A-D EZ Chews, Imodium A-D New Formula, Kao-Paverin, Kaopectate 1-D
Adult Dosing
Acute Diarrhea
- 2mg PO per dose
- Start: 4mg PO x1, then 2mg PO after each loose stool; Max: 16mg/day
Chronic Diarrhea
- 4-8mg/day PO divided QD-tid
- Start: 4mg PO x1, then 2mg PO after each loose stool until maint. dose established; Max: 16mg/day
Pediatric Dosing
Acute diarrhea
- 2-5 yo, 13-20 kg
- Dose: 1mg PO x1 after each loose stool
- Max: 3mg/day
- Use OTC 1mg/5 sol or 1mg/7.5 mL susp
- Dose: 1mg PO x1 after each loose stool
- 6-8 yo, 20-30 kg
- Dose: start 2mg PO x1, then 1mg PO after each loose stool
- Max: 4mg/day
- Dose: start 2mg PO x1, then 1mg PO after each loose stool
- 8-11 yo, 30-40 kg
- Dose: start 2mg PO x1, then 1mg PO after each loose stool
- Max: 6mg/day
- Dose: start 2mg PO x1, then 1mg PO after each loose stool
- 12 yo and older
- Dose: start 4mg PO x1, then 2mg PO after each loose stool
- Max: 8mg/day
- Dose: start 4mg PO x1, then 2mg PO after each loose stool
Chronic diarrhea
- 0.08-0.24mg/kg/day PO divided bid-tid
- Max: 2mg/dose
Special Populations
- Pregnancy Rating: B
- Lactation risk: Probably safe
Renal Dosing
- Adult:
Hepatic Dosing
- Adult/Pediatric: Reduced first-pass metabolism
- CNS toxicity
Contraindications
- Allergy to class/drug
If given with:
- potassium acid phosphate
- potassium chloride
- potassium citrate
- potassium phosphate
Adverse Reactions
Serious
- Loperamide toxicity
- toxic megacolon
- paralytic ileus
- angioedema
- anaphylaxis/anaphylactoid reaction
- toxic epidermal necrolysis
- Stevens-Johnson syndrome
- erythema multiforme
- urinary retention
- heat stroke
Common
Pharmacology
- Half-life: Half-life: 10.8h
- Metabolism: liver; CYP450: 2C8, 3A4 substrate; Info: P-gp substrate; 40% systemic absorption
- Excretion: feces 30%, urine <2%
Mechanism of Action
- binds gut wall opioid receptor, inhibiting peristalsis; increases anal sphinctor tone