Formulary
Loperamide hydrochloride: Indications, Dosing, Side Effects and Interactions
Loperamide hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Loperamide hydrochloride: Indications, Dosing, Side Effects and Interactions
Loperamide hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Symptomatic treatment of acute diarrhoea**
- **Child** (By Mouth): 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** (By Mouth): 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**
- **Adult** (By Mouth): Initially 4-8 mg daily in divided doses, adjusted according to response; maintenance up to 16 mg daily in 2 divided doses.
**Faecal incontinence**
- **Adult** (By Mouth): 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**
- **Adult** (By Mouth): 2-4 mg 4 times a day.
**Symptomatic treatment of acute diarrhoea for loperamide hydrochloride**
- **Child 4-7 years** (By mouth): 1 mg 3-4 times a day for up to 3 days only.
- **Child 8-11 years** (By mouth): 2 mg 4 times a day for up to 5 days.
- **Child 12-17 years** (By mouth): 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 for loperamide hydrochloride**
- **Child 1-11 months** (By mouth): 100-200 micrograms/kg twice daily, to be given 30 minutes before feeds; increased if necessary up to 2 mg/kg daily in divided doses.
- **Child 1-11 years** (By mouth): 100-200 micrograms/kg 3-4 times a day (max. per dose 2 mg), increased if necessary up to 1.25 mg/kg daily in divided doses; maximum 16 mg per day.
- **Child 12-17 years** (By mouth): 2-4 mg 2-4 times a day; maximum 16 mg per day.
Cautions
Not recommended for children under 12 years (in children)
Contraindications
Active ulcerative colitis; antibiotic-associated colitis; bacterial enterocolitis; conditions where abdominal distension develops; conditions where inhibition of peristalsis should be avoided
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
Interactions
**Other interactions (7):**
- Concomitant administration of loperamide (16 mg single dose) with quinidine, or ritonavir, which are both P-glycoprotein inhibitors, resulted in a 2 to 3-fold increase in loperamide plasma levels.
- The concomitant administration of loperamide (4 mg single dose) and itraconazole, an inhibitor of CYP3A4 and P-glycoprotein, resulted in a 3 to 4-fold increase in loperamide plasma concentrations.
- In the same study a CYP2C8 inhibitor, gemfibrozil, increased loperamide by approximately 2-fold.
- The combination of itraconazole and gemfibrozil resulted in a 4-fold increase in peak plasma levels of loperamide and a 13-fold increase in total plasma exposure.
- These increases were not associated with central nervous system (CNS) effects as measured by psychomotor tests (i.e.
- The concomitant administration of loperamide (16 mg single dose) and ketoconazole, an inhibitor of CYP3A4 and P-glycoprotein, resulted in a 5-fold increase in loperamide plasma concentrations.
Pregnancy
Manufacturers advise avoid-no information available.
Breast feeding
Amount probably too small to be harmful.
Hepatic impairment
Manufacturer advises caution-risk of reduced first pass metabolism leading to central nervous system toxicity.
Medicinal forms
Solution,Tablet,Tablet,Capsule
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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