Drug reference

Loperamide hydrochloride

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 93, 94

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Symptomatic treatment of acute diarrhoea ▶BY MOUTH ▶Child 4–7 years: 1 mg 3–4 times a day for up to 3 days only ▶Child 8–11 years: 2 mg 4 times a day for up to 5 days ▶Child 12–17 years: Initially 4 mg, followed by 2 mg for up to 5 days, dose to be taken after each loose stool; usual dose 6–8 mg daily; maximum 16 mg per day ▶Adult: Initially 4 mg, followed by 2 mg for up to 5 days, dose to be taken after each loose stool; usual dose 6–8 mg daily; maximum 16 mg per day Chronic diarrhoea ▶BY MOUTH ▶Adult: Initially 4–8 mg daily in divided doses, adjusted according to response; maintenance up to 16 mg daily in 2 divided doses Faecal incontinence ▶BY MOUTH ▶Adult: Initially 500 micrograms daily, adjusted according to response, maximum daily dose to be given in divided doses; maximum 16 mg per day Pain of bowel colic in palliative care ▶BY MOUTH ▶Adult: 2–4 mg 4 times a day l UNLICENSED USE ▶In children Capsules not licensed for use in children under 8 years. ▶In adults Use for faecal incontinence is an unlicensed indication. Gastro-intestinal system

PDF pages 93, 94

Contra Indications

Active ulcerative colitis. antibiotic- associated colitis. bacterial enterocolitis. conditions where abdominal distension develops. conditions where inhibition of peristalsis should be avoided

PDF page 94

Cautions

Not recommended for children under 12 years (in children)

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Prescribing And Dispensing Information

Palliative care ▶In adults For further information on the use of loperamide in palliative care, see www.medicinescomplete.com/#/content/palliative/loperamide.

PDF page 94

Exceptions To Legal Category

Loperamide can be sold to the public, for use in adults and children over 12 years, provided it is licensed and labelled for the treatment of acute diarrhoea. ▶In adults Loperamide can be sold to the public, provided it is licensed and labelled for the treatment of acute diarrhoea associated with irritable bowel syndrome (after initial diagnosis by a doctor) in adults over 18 years of age.

PDF page 94

Safety

Important Safety Information

MHRA/CHM ADVICE: REPORTS OF SERIOUS CARDIAC ADVERSE REACTIONS WITH HIGH DOSES OF LOPERAMIDE ASSOCIATED WITH ABUSE OR MISUSE (SEPTEMBER 2017) Serious cardiovascular events (such as QT prolongation, torsades de pointes, and cardiac arrest), including fatalities, have been reported in association with large overdoses of loperamide. Healthcare professionals are reminded that if symptoms of overdose occur, naloxone can be given as an antidote. The duration of action of loperamide is longer than that of naloxone (1–3 hours), so repeated treatment with naloxone might be indicated; patients should be monitored closely for at least 48 hours to detect possible CNS depression. Pharmacists should remind patients not to take more than the recommended dose on the label.

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Interactions

→Appendix 1: loperamide

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Side Effects

▶Common or very common Gastrointestinal disorders. headache. nausea ▶Uncommon Dizziness. drowsiness. dry mouth. gastrointestinal discomfort. skin reactions. vomiting ▶Rare or very rare Angioedema. consciousness impaired. coordination abnormal. fatigue. miosis. muscle tone increased. severe cutaneous adverse reactions (SCARs). urinary retention

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Pregnancy

Manufacturers advise avoid—no information available.

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Breast Feeding

Amount probably too small to be harmful.

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Hepatic Impairment

Manufacturer advises caution—risk of reduced ﬁrst pass metabolism leading to central nervous system toxicity.

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Dose and formulations

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution Tablet ▶Loperamide hydrochloride (Non-proprietary) Loperamide hydrochloride 2 mg Loperamide 2mg tablets | 30 tablet P £1.76 DT = £1.54 ▶Norimode (Tillomed Laboratories Ltd) Loperamide hydrochloride 2 mg Norimode 2mg tablets | 30 tablet P £2.15 DT = £1.54 Oral solution ▶Imodium (Janssen-Cilag Ltd) Loperamide hydrochloride 200 microgram per 1 ml Imodium 1mg/5ml oral solution sugar-free | 100 ml P £1.17 DT = £1.17 Capsule ▶Loperamide hydrochloride (Non-proprietary) Loperamide hydrochloride 2 mg Loperamide 2mg capsules | 30 capsule P £2.99 DT = £0.98 Orodispersible tablet ▶Imodium (McNeil Products Ltd) Loperamide hydrochloride 2 mg Imodium Instant Melts 2mg orodispersible tablets sugar-free | 12 tablet p £4.38 sugar-free | 18 tablet p £5.85 DT = £5.85

PDF page 94

Clinical care

Patient And Carer Advice

Medicines for Children leaflet: Loperamide for diarrhoea www.medicinesforchildren.org.uk/loperamide-diarrhoea

PDF page 94

Dose text by age group

Child 4–7 years

1 mg 3–4 times a day for up to 3 days

First-line fragment. Read the complete Indications and Dose section above.

PDF page 93

Child 8–11 years

2 mg 4 times a day for up to 5 days

First-line fragment. Read the complete Indications and Dose section above.

PDF page 93

Child 12–17 years

Initially 4 mg, followed by 2 mg for up

First-line fragment. Read the complete Indications and Dose section above.

PDF page 93

Adult

Initially 4 mg, followed by 2 mg for up to 5 days,

First-line fragment. Read the complete Indications and Dose section above.

PDF page 93

Adult

Initially 4–8 mg daily in divided doses, adjusted

First-line fragment. Read the complete Indications and Dose section above.

PDF page 93

Adult

Initially 500 micrograms daily, adjusted

First-line fragment. Read the complete Indications and Dose section above.

PDF page 93

Adult

2–4 mg 4 times a day

First-line fragment. Read the complete Indications and Dose section above.

PDF page 93

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Loperamide hydrochloride

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 93, 94

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF pages 93, 94

Contra Indications

Active ulcerative colitis. antibiotic- associated colitis. bacterial enterocolitis. conditions where abdominal distension develops. conditions where inhibition of peristalsis should be avoided

PDF page 94

Cautions

Not recommended for children under 12 years (in children)

PDF page 94

Prescribing And Dispensing Information

Palliative care ▶In adults For further information on the use of loperamide in palliative care, see www.medicinescomplete.com/#/content/palliative/loperamide.

PDF page 94

Exceptions To Legal Category

PDF page 94

Safety

Important Safety Information

PDF page 94

Interactions

→Appendix 1: loperamide

PDF page 94

Side Effects

PDF page 94

Pregnancy

Manufacturers advise avoid—no information available.

PDF page 94

Breast Feeding

Amount probably too small to be harmful.

PDF page 94

Hepatic Impairment

Manufacturer advises caution—risk of reduced ﬁrst pass metabolism leading to central nervous system toxicity.

PDF page 94

Dose and formulations

Medicinal Forms

PDF page 94

Clinical care

Patient And Carer Advice

Medicines for Children leaflet: Loperamide for diarrhoea www.medicinesforchildren.org.uk/loperamide-diarrhoea

PDF page 94

Dose text by age group

Child 4–7 years

1 mg 3–4 times a day for up to 3 days

First-line fragment. Read the complete Indications and Dose section above.

PDF page 93

Child 8–11 years

2 mg 4 times a day for up to 5 days

First-line fragment. Read the complete Indications and Dose section above.

PDF page 93

Child 12–17 years

Initially 4 mg, followed by 2 mg for up

First-line fragment. Read the complete Indications and Dose section above.

PDF page 93

Adult

Initially 4 mg, followed by 2 mg for up to 5 days,

First-line fragment. Read the complete Indications and Dose section above.

PDF page 93

Adult

Initially 4–8 mg daily in divided doses, adjusted

First-line fragment. Read the complete Indications and Dose section above.

PDF page 93

Adult

Initially 500 micrograms daily, adjusted

First-line fragment. Read the complete Indications and Dose section above.

PDF page 93

Adult

2–4 mg 4 times a day

First-line fragment. Read the complete Indications and Dose section above.

PDF page 93

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.