loperamide hydrochloride

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loperamide hydrochloride

Apo-Loperamide (CA), Arret (UK), Diah-Limit (UK), Diamode, Diaquitte (UK), Diareze (UK), Diarr-Eze (CA), Diarrhea Relief (CA), Diocalm Ultra (UK), Diocaps (UK), Dom-Loperamide (CA), Entocalm (UK), Imodium, Imodium A-D, K-Pek II, Loperacap (CA), Norimode (UK), Normaloe (UK), Novo-Loperamide (CA), PHL-Loperamide (CA), PMS-Loperamine (CA), Riva-Loperamine (CA), Sandoz Loperamide

Pharmacologic class: Piperidine derivative

Therapeutic class: Antidiarrheal

Pregnancy risk category B

Action

Inhibits peristalsis of intestinal wall musculature and intestinal contents. Also reduces fecal volume, increases fecal bulk, and minimizes fluid and electrolyte loss.

Availability

Capsules: 2 mg

Solution: 1 mg/5 ml

Tablets: 2 mg

Tablets (chewable): 2 mg

Indications and dosages

Acute diarrhea

Adults: Initially, 4 mg P.O., then 2 mg after each loose stool. Usual maintenance dosage is 4 to 8 mg P.O. daily in divided doses, not to exceed 16 mg daily.

Children ages 8 to 12 or weighing more than 30 kg (66 lb): Initially, 2 mg P.O. t.i.d., then 1 mg/10 kg after each loose stool, not to exceed 6 mg daily

Children ages 6 to 8 or weighing 20 to 30 kg (44 to 66 lb): Initially, 2 mg P.O. b.i.d., then 1 mg/10 kg after each loose stool, not to exceed 4 mg daily

Children ages 2 to 5 or weighing 13 to 20 kg (29 to 44 lb): Initially, 1 mg P.O. t.i.d., then 1 mg/10 kg after each loose stool, not to exceed 3 mg daily

Acute diarrhea (treated with over-the-counter loperamide)

Adults and children ages 12 and older: Two caplets with 4 to 8 oz water after first loose stool, then one caplet (with 4 to 8 oz water) after each subsequent loose stool. Don't exceed four caplets in 24 hours. Or give equivalent dosage in liquid form.

Children ages 9 to 11 who weigh 27 to 43 kg (60 to 95 lbs): One caplet with 4 to 8 oz water after first loose stool, then ½ caplet (with 4 to 8 oz water) after each subsequent loose stool. Don't exceed three caplets in 24 hours. Or give equivalent dosage in liquid form.

Children ages 6 to 8 who weigh 22 to 27 kg (48 to 59 lbs): One caplet with 4 to 8 oz water after first loose stool, then ½ caplet with 4 to 8 oz water after each subsequent loose stool. Don't exceed two caplets in 24 hours. Or give equivalent dosage in liquid form.

Children younger than age 6: Consult physician.

Chronic diarrhea

Adults: Initially, 4 mg P.O., then 2 mg after each loose stool; reduce dosage as tolerated. Don't exceed 16 mg daily for more than 10 days.

Contraindications

• Hypersensitivity to drug
• Abdominal pain of unknown cause (especially with fever)
• Acute diarrhea caused by enteroinvasive Escherichia coli, Salmonella, or Shigella
• Acute ulcerative colitis
• Bloody diarrhea with temperature above 38.3 °C (101 °F) (with OTC product)
• Pseudomembranous colitis associated with broad-spectrum anti-infectives
• Children younger than age 6

Precautions

Use cautiously in:
• hepatic disease
• elderly patients
• pregnant or breastfeeding patients
• children.

Administration

• Use patient's weight to determine appropriate dosage (especially in children).

Adverse reactions

CNS: drowsiness, dizziness

GI: nausea; vomiting; constipation; abdominal pain, distention, ordiscomfort; dry mouth; toxic megacolon (in patients with acute ulcerative colitis)

Other: allergic reactions

Interactions

Drug-drug.Antidepressants, antihistamines, other anticholinergics: additive anticholinergic effects

CNS depressants (including antihistamines, opioid analgesics, sedative-hypnotics): additive CNS depression

Drug-herbs.Chamomile, hops, kava, skullcap, valerian: increased CNS depression

Drug-behaviors.Alcohol use: increased CNS depression

Patient monitoring

Watch for signs and symptoms of abdominal distention, which may signal toxic megacolon in patient with ulcerative colitis.
• Assess bowel movements to evaluate drug efficacy and determine need for repeat doses.
• Monitor stool cultures as indicated.
• Check stool for occult blood as indicated.
• Evaluate fluid intake and output.
• Stay alert for CNS effects, especially in children.

Patient teaching

• Stress importance of maintaining high fluid intake to prevent dehydration.

Instruct patient or parents to report fever, mucus in stool, or history of hepatic disease before using drug.

Caution patient or parents to discontinue drug if symptoms worsen or diarrhea lasts longer than 2 days.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above.

loperamide hydrochloride

[lōper′əmīd]
an antiperistaltic.
indication It is prescribed in the treatment of diarrhea.
contraindications Known hypersensitivity to this drug prohibits its use. It is not given to patients in whom constipation must be avoided.
adverse effects Among the most serious effects are abdominal pain, constipation, nausea, and vomiting.