Loperamide
IMODIUM
Pronunciation: loe-PER-a-mide
“Loops Immobilize peristalsis”
What it isPeripherally restricted mu agonist slowing gut transit; diarrhea.
Why this oneP-glycoprotein keeps it out of the CNS, so it controls diarrhea without euphoria or dependence at normal doses.
What limits itAt the supratherapeutic doses used for abuse it saturates P-gp and causes torsades and death. Avoid in inflammatory or invasive colitis.
FDA-approved for
- diarrhea (1976)
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Diarrhea (OTC) | Adults & children ≥12 yr | 2 caplets after first loose stool, then 1 after each subsequent loose stool | 4 caplets/24 hr | |
| Diarrhea (OTC) | Children 9–11 yr (60–95 lb) | 1 caplet after first loose stool, then ½ after each subsequent | 3 caplets/24 hr | |
| Diarrhea (OTC) | Children 6–8 yr (48–59 lb) | 1 caplet after first loose stool, then ½ after each subsequent | 2 caplets/24 hr |
Renal Undefined
Hepatic Undefined
Instructions
- Drink plenty of clear fluids to prevent dehydration
- Children 2–5 yr (34–47 lb): ask a doctor; children under 2 yr: do not use
Available strengths
- cap 1, 2 mg
- tab 2 mg
- sol 1 mg/5 mL
- susp 1 mg/7.5 mL
Pregnancy Undefined
Lactation Undefined
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 1 mg | cap | per unit | not offered | |
| 2 mg | cap | per unit | $0.05/ea | offered |
Generic entry1991
NO BOXED WARNINGS
Principal riskTorsades at the supratherapeutic doses used for abuse
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityTherapeutic CNS effects are minimal, but high-dose misuse can cause fatal sodium/potassium-channel cardiotoxicity.
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