Side effects of imodium



Loperamide is the generic form of the brand-name drug Imodium, a medication used to treat diarrhea.

Imodium works by slowing down the movement of the gut. This decreases the number of bowel movements and makes stool less watery.

Imodium may also be used to decrease the amount of discharge in patients who have undergone an ileostomy (a procedure to move waste out of the body when the colon or rectum is not working properly) or to treat people with inflammatory bowel disease (IBD).

Imodium comes as a tablet, capsule, and liquid to take by mouth. It’s available with or without a prescription.

Imodium Warnings

Children younger than age 6 should not use Imodium unless directed by their doctor. This medicine should never be used in infants younger than 24 months.

It may take up to 48 hours for your symptoms to improve.

Call your doctor if your symptoms do not improve within two days of taking Imodium (10 days for chronic diarrhea), or if you develop bloody stools or a fever.

Drink plenty of fluids to make up for losses during diarrhea.

Don’t take if your stools are bloody, black, or tarry, or if you have diarrhea that is caused by taking antibiotics.

Tell your doctor if have a fever, mucus in your stools, a history of liver disease, or if you are taking an antibiotic.

Imodium treats the symptoms of diarrhea, not the cause. Your doctor will determine how to best treat the causes of diarrhea.

Pregnancy and Imodium

It’s not known whether Imodium will harm an unborn baby. Tell your doctor if you are pregnant or might become pregnant while taking Imodium.

The drug can also pass into breast milk and may harm a breastfeeding baby. Do not breastfeed while taking Imodium.

Imodium for Dogs

Some veterinarians have used Imodium to treat diarrhea in dogs.

If your dog has diarrhea that’s severe or long-lasting (more than 48 hours), is vomiting, or there’s blood in the diarrhea, discontinue using Imodium and contact your vet immediately.

Imodium can cause severe side effects in cats, and is not recommended for them.

Imodium ‘High’ and Abuse

Imodium contains a very small amount of opiates, and a growing number of anecdotal and scientific reports have revealed that some opioid painkiller addicts are ingesting large amounts of Imodium to get a mild narcotic high.

Abusing any opioid has serious health risks and can result in life-threatening irregular heartbeats and death.

A 2016 report in the Annals of Emergency Medicine described how two men died after overdosing on Imodium.

Imodium A-D

Generic Name: loperamide (loe PER a mide)
Brand Names: Diamode, Imodium A-D, Anti-Diarrheal

Medically reviewed by Sophia Entringer, PharmD Last updated on May 1, 2019.

  • Overview
  • Side Effects
  • Dosage
  • Interactions
  • Pregnancy
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What is Imodium A-D?

Imodium A-D (loperamide) slows the rhythm of digestion so that the small intestines have more time to absorb fluid and nutrients from the foods you eat.

Imodium A-D is used to treat diarrhea.

Imodium A-D is also used to reduce the amount of stool in people who have an ileostomy (re-routing of the bowel through a surgical opening in the stomach).

Important Information

You should not use Imodium A-D if you have ulcerative colitis, bloody or tarry stools, diarrhea with a high fever, or diarrhea caused by antibiotic medication.

Do not take more than the recommended dose of this medicine. Misuse of loperamide can cause serious heart problems that could be fatal.

Serious heart problems may also happen if you take Imodium A-D with other medicines. Ask a doctor or pharmacist about safely using medications together.

Loperamide may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Imodium A-D should not be given to a child younger than 2 years old. Loperamide can cause serious breathing problems and heart problems in a child.

Drink plenty of liquids while you are taking this medicine. It may take up to 48 hours of taking Imodium A-D before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve after 10 days of treatment.

Before taking this medicine

You should not use Imodium A-D if you are allergic to loperamide, or if you have:

  • stomach pain without diarrhea;

  • diarrhea with a high fever;

  • ulcerative colitis;

  • diarrhea that is caused by a bacterial infection; or

  • stools that are bloody, black, or tarry.

Do not give Imodium A-D to a child younger than 2 years old. Do not give this medicine to an older child or teenager without a doctor’s advice.

Ask a doctor or pharmacist if it is safe for you to use this medicine if you have:

  • a fever;

  • mucus in your stools;

  • liver disease; or

  • a heart rhythm disorder.

Ask your doctor before using Imodium A-D to treat diarrhea caused by Clostridium difficile.

Ask a doctor before using this medicine if you are pregnant or breastfeeding.

You should not breast-feed while you are using loperamide.

How should I take Imodium A-D?

Use Imodium A-D exactly as directed on the label, or as prescribed by your doctor.


Carefully follow all dosing directions on the medicine label. A safe dose of loperamide is different for an adult than for a child. This medicine doses in children are based on the child’s age.

Take Imodium A-D with a full glass of water. Diarrhea can cause your body to lose fluids and electrolytes. Drink plenty of liquids to keep from getting dehydrated.

The chewable tablet must be chewed before swallowing. Take the chewable tablet on an empty stomach (1 hour before or 2 hours after a meal)

Shake the oral suspension (liquid) before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

Not all liquid forms of this medicine are the same strengths. Carefully follow all dosing instructions for the medicine you are using.

Store at room temperature away from moisture and heat. Do not allow the liquid medicine to freeze.

Stop taking Imodium A-D and call your doctor if you still have diarrhea after 2 days of treatment, or if you also have stomach bloating.

What happens if I miss a dose?

Since Imodium A-D is used when needed, it does not have a daily dosing schedule. Call your doctor if your symptoms do not improve after using this medicine.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of loperamide can be fatal.

Overdose symptoms may include fast or irregular heartbeats, or fainting. A person caring for you should seek emergency medical attention if you pass out and are hard to wake up.

What should I avoid while taking Imodium A-D?

Avoid drinking tonic water. It can interact with loperamide and may cause serious heart problems.

Avoid becoming dehydrated by drinking plenty of fluids. Avoid vigorous exercise or exposure to hot weather if you are dehydrated.

Imodium A-D liquid may contain alcohol. Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired.

Imodium A-D side effects

Get emergency medical help if you have signs of an allergic reaction to Imodium A-D (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Stop taking this medicine and call your doctor at once if you have:

  • diarrhea that is watery or bloody;

  • stomach pain or bloating;

  • ongoing or worsening diarrhea; or

  • fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out).

Common Imodium A-D side effects may include:

  • constipation;

  • dizziness, drowsiness;

  • nausea; or

  • stomach cramps.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Imodium A-D?

Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take. Ask a doctor or pharmacist about safely using medications together.

Loperamide can cause a serious heart problem with high doses.

Many drugs can affect loperamide. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Imodium A-D only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2020 Cerner Multum, Inc. Version: 9.01.

Medical Disclaimer

More about Imodium A-D (loperamide)

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  • Drug class: antidiarrheals
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Consumer resources

  • Imodium A-D
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Other brands: Diamode, Imotil, Kao-Paverin

Professional resources

  • Loperamide Hydrochloride (AHFS Monograph)
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Other Formulations

  • Imodium

Related treatment guides

  • Diarrhea, Chronic
  • Diarrhea, Acute
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  • Diarrhea

No doubt you’ve heard that America is in the middle of an opioid epidemic. People are getting hooked on and abusing painkillers like oxycodone(which goes by the brand name Oxycontin and is also in Percocet) and morphine,with dangerous side effects. In recent tragic news, Prince died from an accidental overdose of the opioid fentanyl, which is 100 times stronger than heroin. Now that doctors have wised up to the issue, many are scaling back on how often they prescribe these drugs. As a result, addicts are turning to less conventional, over-the-counter ways to try to get high. The latest: Imodium, a medication that treats diarrhea.

The Food and Drug Administration released a report earlier this week that people are taking high doses of the drug loperamide (best known as Imodium) to try to get the same high they get from abusing opioids. The danger in that (besides extreme constipation): They can develop heart problems and even die.

While it seems weird that Imodium could get you high, experts say there’s a reason behind the disturbing trend. Loperamide works on opioid receptors, which are the same receptors that are hit by Oxycontin, heroin, and other opioid drugs, Kyle Staller, M.D., a gastroenterologist at Massachusetts General Hospital, tells SELF. “At normal doses, loperamide doesn’t really cross the blood-brain barrier, and that prevents you from experiencing a high,” he explains. “But if you take it at a high enough dose, a small amount can get into the brain and act on those opioid receptors, getting you high.”

If you have to take Imodium for diarrhea, is this something you should be worried about? James Galligan, Ph.D., a professor of pharmacology and toxicology, and director of the neuroscience program at Michigan State University, says no. “It’s impossible to accidentally overdose on loperamide,” he tells SELF.

Here’s why: Loperamide is approved for use in a single dose of four milligrams for the first dose, followed by two milligrams if you’re still having issues. The maximum approved daily dose, per the FDA, is eight milligrams per day for over-the-counter use and 16 milligrams a day for prescription use.

But people who are abusing loperamide are taking up to 300 milligrams. They’re also taking it in combination with other drugs to try to increase its absorption and penetration across the blood-brain barrier, the FDA says.

Basically, you shouldn’t worry that you’re going to get high if you take an Imodium, can’t remember how long ago you took it, and take another one in less than four hours.

“There is really no risk,” Galligan says. “Loperamide has been used for many, many years.” The primary side effect if you take loperamide in its recommended dosage is constipation, which has its own issues but is something of a welcome change after dealing with diarrhea.

However, some people report dizziness, a drowsy feeling, stomach pain, and even a skin rash when taking Imodium, women’s health expert Jennifer Wider, M.D., tells SELF. “It’s always super important to follow the dosing instructions because like other medications, Imodium can cause side effects,” she says.

But, “in general, loperamide is an incredibly safe drug,” says Staller. “The average person shouldn’t worry about this warning.”


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Watch: The Future Of Legal Marijuana Illustrated With Marijuana

Imodium Interaction With Alcohol And Other Medications

Loperamide interactions with other drugs and substances may change the way this medication works and result in unpredictable consequences. Sometimes, Imodium interactions can be beneficial and improve the patient’s condition. In many cases, however, combining loperamide and other medications may worsen the existing Imodium A-D side effects and pose significant health risks.

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Table of Contents

  • How Does Loperamide Interact With Alcohol?
  • How Does Loperamide Interact With Other Medications?
  • How To Safely Combine Loperamide And Other Drugs?

Imodium And Alcohol

Risks of Mixing Both

Drinking alcoholic beverages is generally inadvisable during loperamide treatment. Even when the consumption is moderate, Imodium interaction with alcohol can result in heightened side effects of loperamide. It can also make the action of the medicine weaker. In addition, considering what Imodium is used for, mixing Imodium and alcohol can work to counter the drug by worsening existing diarrhea.

Side Effects Of Taking Loperamide And Alcohol

The combination of loperamide and alcohol can aggravate the nervous system side effects of the medication, namely dizziness, sleepiness, difficulty concentrating, and fatigue. Moreover, certain severe symptoms might develop. Those include confusion, impaired thinking, and delusions. Drowsiness is a relatively common side effect of Imodium, and it might linger even after the alcohol is out of the person’s system.

Therefore, the individual should be careful and avoid tasks that require high alertness such as driving until they know how loperamide affects them after drinking.

Taking A Large Amount Of Alcohol With Imodium

The worst-case scenario can occur when a person mixes large amounts of alcohol and Imodium.

Since both substances work through depressing the central nervous system, their combination significantly increases the risk of overdose.

Imodium Interactions With Other Medications

Many people take other over-the-counter or prescription medicines along loperamide. Certain drugs may be taken to imitate the effects of Imodium Multi-Symptom Relief caplets or boost the effectiveness of the medication. While many loperamide interactions can be beneficial, some can pose a serious threat to a person’s health. It is essential to learn about the most frequent Imodium interactions with other substances and consult with a doctor before changing the dose or introducing new medicines.

Imodium And Metformin

Metformin is a diabetes medication that is known to cause moderate and severe diarrhea in many patients. Individuals can take Imodium with metformin to ease this symptom. Loperamide does not interact with metformin. However, it should be used with caution if any side effects are present since they can worsen the negative symptoms of metformin as well.

Imodium And Omeprazole

Those who abuse Imodium sometimes uses the combination of loperamide and omeprazole. Imodium A-D high is hard to achieve since the drug can’t effectively cross the blood-brain barrier by itself. Mixing omeprazole with loperamide allows the latter to display its opioid properties stronger and enables the user to take lower doses of the drug to get the same results. However, it also makes the person more susceptible to the effects of other substances that are present in their system when they take omeprazole.

Imodium And Suboxone

Suboxone is a medication used in opioid replacement therapy that can cause diarrhea. Loperamide and Suboxone can be taken together to ease gastrointestinal side effects of Suboxone as long as the person takes both medicines properly. Large doses of loperamide can induce high and consequently negate Suboxone treatment.

Imodium And Blood Thinners

Some antidiarrheal medicines such as Pepto-Bismol are known to interact with various blood thinners. There are reports of worsened side effects during the concurrent use of loperamide and blood thinners; still, there is little evidence of significant interaction between the medications.

Imodium And Zantac

Imodium drug interaction with Zantac is strong and can be fatal. Ranitidine tends to increase the level of loperamide in blood. This can result in cardiac arrest, irregular heartbeat, and other heart problems. Patients with congenital long QT syndrome, electrolyte disturbances, and conduction abnormalities should be particularly cautious when taking Zantac with loperamide. In some cases, doctors will prescribe Imodium alternative medicines that will not interact with Zantac.

Imodium And Antibiotics

The question of whether a person can take Imodium with antibiotics periodically arises since diarrhea is a side effect of many antibiotic medications. It is generally stated that an individual should not take Imodium with antibiotics because it can interfere with the course of treatment. Antidiarrheals inhibit the intestine’s ability to eliminate toxins, which can lead to various complications. The adverse effects of antibiotics should normally disappear on their own after several days.

Safe Use Of Loperamide With Other Drugs

Specific Imodium drug interactions can lead to serious health conditions and even death. The most hazardous medicines include Zantac, cholestyramine, opioid pain medications, ritonavir, and medicines that affect the heart rhythm.

Some substances can increase the effectiveness of loperamide and subsequently lead to Imodium overdose. Overdosing on loperamide can be fatal. It is especially common among those who are dissatisfied with how long Imodium lasts or abuse the drug to get euphoric. Extremely high doses of loperamide can lead to severe liver problems, vomiting, and heart attacks.

An individual should avoid using loperamide to treat diarrhea associated with antibiotic treatment. When it comes to other drugs, it is crucial to research potential interactions before taking medicines alongside loperamide. If a person experiences persistent side effects during short-term treatment for mild diarrhea, it is advisable to receive medical consultation. A doctor can prescribe an alternative to any of the conflicting drugs and help avoid long-lasting and dangerous symptoms. If a patient misuses the medication, it is vital to reach drug rehabilitation facilities as soon as possible to get the proper treatment.

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Loperamide (including Imodium)

If you’ve bought loperamide from a pharmacy or shop, follow the instructions that come with the packet.

If your doctor has prescribed loperamide for you or your child, follow their instructions about how and when to take it.

Different ways of taking loperamide

Loperamide comes as:

  • tablets and hard or soft capsules (2mg)
  • tablets that dissolve on your tongue (2mg) – these are called Imodium Instants or Imodium Instant Melts
  • a liquid medicine (labelled 1mg/5ml) – the liquid is only available on prescription

The capsules and tablets all contain the same amount of loperamide (2mg) whether you get them on prescription or buy them yourself. They all work as well as each other but some of the products have different labels.

Some supermarkets and pharmacies sell their own versions of loperamide, usually called ‘anti-diarrhoea’ or ‘diarrhoea relief’ capsules. Some products have ‘IBS’ in the name so people realise they can be used for attacks of diarrhoea with IBS. However, they’re no different from other brands. People with IBS can also use brands without ‘IBS’ in the name.

If you’re not sure which brand or form of loperamide to get, talk to your pharmacist.

You can also get loperamide combined with simethicone to help if you have painful wind and bloating as well as diarrhoea. This is called Imodium Plus Caplets and Imodium Plus Comfort Tablets.

How to take it

You can take loperamide with or without food.

  • Capsules and tablets – swallow them whole with a drink of water.
  • Tablets which melt in your mouth – put the tablet on your tongue and let it melt in your saliva. You can then swallow it without a drink. Do not chew it.
  • Liquid loperamide – this comes with a measuring cup, plastic syringe or spoon to help you measure the right dose. If you don’t have one, ask your pharmacist. Do not use a kitchen teaspoon as it will not give the right amount of medicine.

How much should I take?

This depends on the type of diarrhoea you have and your age.

Adults (over 18 years old), including adults with IBS

The usual dose is:

  • capsules or tablets: take 2 capsules or tablets straight away. Then take 1 capsule or tablet after each runny poo.
  • liquid: take 4 spoonfuls (5ml each) straight away. Then take 2 spoonfuls after each runny poo.

Stop taking loperamide as soon as your symptoms settle down.

The recommended maximum daily dose is:

  • 6 capsules or tablets in 24 hours if you bought them from a shop
  • 8 capsules or tablets or 16 spoonfuls of liquid (5ml each) in 24 hours if you bought them from a pharmacy or your doctor prescribed loperamide

Do not take loperamide for more than 48 hours without talking to a doctor.

Adults (over 18 years old) with long lasting diarrhoea

Most cases of diarrhoea get better in 5 to 7 days. If your diarrhoea doesn’t stop in 7 days, talk to your doctor. It is important to understand the causes and to treat any complications, for instance dehydration.

If your doctor prescribes loperamide for long lasting diarrhoea, they will tell you how much to take. The usual starting dose is:

  • 2 to 4 capsules or tablets spread over the day
  • 4 to 8 spoonfuls of liquid loperamide (5ml each) spread over the day

Your doctor will adjust your dose according to your symptoms, up to a maximum of:

  • 8 tablets or capsules in 24 hours
  • 16 spoonfuls of liquid loperamide (5ml each) in 24 hours

Once you’re on the right dose, your doctor will usually recommend splitting your dose so you take half in the morning and half in the afternoon or evening.

Occasionally patients with a stoma need a higher dose. Only take a higher dose if your doctor tells you to.


You can give children over 12 years old with short term diarrhoea the same dose as adults. But if they are 12 to 17 years old and have IBS or long lasting diarrhoea, they should only take it if their doctor prescribes it.

Do not give loperamide to children under 12 years old unless their doctor prescribes it.

If a doctor prescribes loperamide for a child under 12 – or for a child aged 12 to 17 years old with IBS or long lasting diarrhoea – they will use your child’s weight or age to work out the right dose. The dose also depends on your child’s symptoms.

What if I forget to take it?

If you miss a dose of loperamide, don’t worry. Just take another dose after you next go to the toilet and have a runny poo. Do not take a double dose to make up for the one you forgot.

What if I take too much?

Do not take more than the recommended amount.

If you take an extra dose of loperamide by accident, it’s unlikely to harm you. But taking higher doses can cause serious heart problems. The signs include having a fast or irregular heartbeat.

Speak to your pharmacist or doctor if you’re worried or take more than 1 extra dose.

Imodium Capsule


Before taking loperamide, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: stomach/abdominal pain without diarrhea, bowel obstruction (e.g., ileus, megacolon, abdominal distention).

The rapidly dissolving tablets may contain aspartame or phenylalanine. If you have phenylketonuria (PKU) or any other condition that requires you to restrict your intake of aspartame or phenylalanine, consult your doctor or pharmacist regarding the safe use of this medicine.

Antibiotics may rarely cause a severe intestinal condition (Clostridium difficile-associated diarrhea) due to a type of resistant bacteria. Symptoms include: persistent diarrhea, abdominal or stomach pain/cramping, or blood/mucus in your stool. This condition may occur weeks after antibiotic treatment has stopped. This medication may make this condition worse. Do not use this anti-diarrhea product, especially after recent antibiotic use, if you have the above symptoms without talking with your doctor first.

This medication should not be used without seeing your doctor first if you have certain medical conditions. These symptoms/conditions may require other treatment before you can use this medication safely. Before using this medication, tell your doctor or pharmacist your medical history, especially of: black/tarry stool, blood/mucus in your stool, high fever, HIV infection/AIDS, liver problems, certain stomach/intestinal infections (e.g., Salmonella, Shigella), certain type of bowel disease (acute ulcerative colitis).

Loperamide may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.

The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using loperamide, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).

Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/”water pills”) or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using loperamide safely.

This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

Older adults may be more sensitive to the side effects of this drug, especially QT prolongation (see above).

Children may be more sensitive to the effects of this drug, especially drowsiness. Children are also at a higher risk for dehydration. See also Warning and How to Use sections.

During pregnancy, this medication should be used only if clearly needed. Discuss the risks and benefits with your doctor.

This drug passes into breast milk but is unlikely to have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

GaryBess1’s blog

Looking for imodium without prescription? No problem!

Date: 4.04.2012
nick: melmole

can you take imodium on an empty stomach

Can i take pepto bismol or immodium on an empty stomach or should.

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Best Answer: Shouldn’t matter that much… from their site: Should I take Pepto-Bismol with or without food? Pepto-Bismol can be taken before or after.
How to use Imodium Oral. If you are using the over-the. If you are taking the chewable tablet, take this medication on an empty stomach.

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    About loperamide

    Type of medicine An antimotility medicine
    Used for Acute diarrhoea
    Also called Diah-Limit®; Diocalm®; Dioraleze®; Entrocalm®; Imodium®; Norimode®; Normaloe®
    Available as Capsules, tablets, ‘instant’ (dissolve-in-the-mouth) tablets, and oral liquid medicine

    Loperamide is a medicine that can help if you have acute diarrhoea. Acute diarrhoea in adults starts suddenly and in most cases eases within a few days. The main treatment is to have lots to drink to prevent dehydration. The most common cause of acute diarrhoea is an infection. Many bacteria, viruses, and other germs can cause diarrhoea. In most cases the diarrhoea settles as your body’s immune system clears the infection. Antidiarrhoeal medicines like loperamide may not be necessary; however, they can be helpful if you wish to reduce the number of trips that you need to make to the toilet. Most people only need to take loperamide for a day or so.

    Loperamide works by slowing down the activity of your bowel. This reduces the speed at which the contents pass through, and so food remains in your intestines for longer. This allows more water to be absorbed back into your body and results in firmer stools that are passed less often.

    Because loperamide regulates the passage of food through the digestive system, it can also help people with diarrhoea associated with irritable bowel syndrome, and people who need help to regulate their bowel activity following surgery on the intestines.

    You can buy loperamide from retail outlets or get it on prescription from your doctor; however, it is not suitable for children under the age of 12 years unless it has been prescribed by a doctor.

    Before taking loperamide

    To make sure this is the right treatment for you, before you start taking loperamide it is important that you speak with your doctor or pharmacist:

    • If you are pregnant or breast-feeding.
    • If you have liver problems.
    • If you have a long-term bowel condition such as ulcerative colitis.
    • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
    • If you have ever had an allergic reaction to a medicine.

    How to take loperamide

    • Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about loperamide and will provide you with a full list of the side-effects which you may experience from taking it.
    • Take loperamide exactly as your doctor tells you to, or as directed on the label. The usual dose for acute diarrhoea in an adult is 4 mg (two tablets/capsules) taken straightaway, followed by 2 mg (one tablet/capsule) after each time you go to the toilet with diarrhoea. This usually means taking three or four tablets/capsules a day. Never take more than eight tablets/capsules a day. If your symptoms continue for more than 48 hours, you should speak with a doctor if you have not already done so. Stop taking loperamide as soon as your symptoms settle down.
    • Most loperamide capsules and tablets are best swallowed with a drink of water. However, if you have been given a brand called Imodium® Instants, these are specially designed to dissolve in your mouth – place the tablet on your tongue and allow it to dissolve there before you swallow.
    • Loperamide should only be taken by a child under 12 years of age on the advice of a doctor. If your child has been prescribed loperamide liquid medicine, check the label on the bottle carefully to make sure you know what dose to give.
    • If you forget to take a dose, do not worry, just take a dose after the next time you go to the toilet with diarrhoea. Do not take two doses together to make up for a missed dose.

    Getting the most from your treatment

    • It is important that you have lots to drink to prevent you from becoming dehydrated. Drinking plain water is ideal, but juice and/or soup are also suitable. Try to avoid drinks that contain a lot of sugar, such as cola or pop, as they can sometimes make diarrhoea worse.
    • Oral rehydration salts can be taken to help prevent dehydration and replace lost salts. These are especially recommended for children and for people who are frail or who have underlying health problems. You can buy these from a pharmacy.
    • Eat small, light meals as soon as you are able. Plain foods such as bread and rice are good foods to try eating first.
    • If your symptoms continue for more than 48 hours, speak with a doctor or pharmacist for advice if you have not already done so. If loperamide has been prescribed by your doctor and your diarrhoea has not settled after five days, you should return to your doctor for further advice.
    • If your symptoms get worse, or if you develop a high temperature, or if you pass blood in the diarrhoea, you should consult a doctor for advice as soon as possible.

    Can loperamide cause problems?

    Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with loperamide. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

    Common loperamide side-effects (these affect less than 1 in 10 people) What can I do if I experience this?
    Constipation Stop taking loperamide
    Wind (flatulence), feeling dizzy This should soon pass. If it becomes troublesome, stop taking loperamide
    Headache Drink plenty of water and ask your pharmacist to recommend a suitable painkiller.
    Feeling sick Try taking loperamide after eating some food if you are not already doing so

    If you experience any other symptoms which you think may be due to loperamide, speak with your doctor or pharmacist for further advice.

    How to store loperamide

    • Keep all medicines out of the sight and reach of children.
    • Store in a cool, dry place, away from direct heat and light.

    Important information about all medicines

    Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

    If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking.

    If you buy any medicines, check with a pharmacist that they are suitable to take with your other medicines.

    This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

    Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

    If you have any questions about this medicine ask your pharmacist.

    Easy-to-read medicine information about loperamide – what it is, how to take loperamide safely and possible side effects.

    Type of medicine Also called
    • Belongs to a group of medicines known as anti-motility agents (slows the gut)
    • Medicine for diarrhoea (stops runny poos)
    • Diamide Relief®
    • Diamide®
    • Diafix®
    • Gastro-stop®
    • Imodium®
    • Imodium Zapid®
    • Lorrex®
    • Nodia®

    What is loperamide?

    Loperamide is used to treat diarrhoea (runny poos). It works by slowing the movement of the gut, and in this way reduces the number of bowel motions and firms up runny poos. Loperamide helps to ease diarrhoea but does not treat the cause of diarrhoea, such as infection or a tummy bug. Read more about diarrhoea.
    Loperamide is also used in people who have undergone an ileostomy (an operation that removed part of the bowel), to thicken your stool and reduce the amount of output from your ileostomy.
    In New Zealand, loperamide comes as capsules (2 mg) or tablets (2 mg) and orally disintegrating tablets (2 mg). It is available on prescription from your doctor or can be bought from your pharmacy without a prescription.


    • The dose of loperamide will be different for different people, depending on your condition.
    • For sudden (acute) diarrhoea: take 4 mg( 2 tablets or capsules) to start, then 2 mg (1 tablet or capsule) after each time you go to the toilet with diarrhoea. Do not take more than 8 tablets or capsules in 24 hours. Stop taking loperamide as soon as the diarrhoea stops. If the diarrhoea continues for longer than 48 hours, contact your doctor.
    • For long-lasting (chronic) diarrhoea: start with 2 capsules or tablets daily and adjust your dose until you have 1 to 2 solid stools a day. The usual dose ranges from 2 to 12 mg daily (1 to 6 capsules or tablets daily). Do not take more than 8 tablets or capsules in 24 hours.
    • If your doctor has prescribed loperamide, then take it exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much loperamide to take, how often to take it, and any special instructions.
    • Swallow the capsule or tablet with a glass of water.
    • The orally disintegrating tablets (Imodium Zapid®) melt on your tongue without the need for water.
    • Loperamide can be taken before or after food.
    • If you forget to take a dose, just take a dose after the next time you go to the toilet with diarrhoea. Do not take two doses together to make up for a missed dose.
    • Make sure you drink plenty of water or electrolyte replacement drinks because diarrhoea can make you dehydrated. Talk to your doctor or pharmacist about this.

    Precautions – before taking loperamide

    • Do have ulcerative colitis?
    • Do you have problems with your liver?
    • Are you pregnant or breastfeeding?
    • Do you have blood in your stools (poo) with a high fever?
    • Do you know if your diarrhoea has been caused by bacteria called Salmonella or Campylobacter or from antibiotic use?
    • Are you taking or using any other medicines? This includes any medicines being taken which are available to buy without a prescription, as well as herbal and complementary medicines.

    If so, it’s important that you tell your doctor or pharmacist before taking loperamide. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

    Possible side effects

    Like all medicines, loperamide can cause side effects, although not everyone gets them. Often side effects improve as your body adjusts to the new medicine.

    Side effects What should I do?
    • Constipation
    • Stop taking loperamide.
    • Tell your doctor if troublesome
    • Gas, bloating, wind
    • Headache
    • These are quite common when you take loperamide and usually goes away with time
    • Signs of obstruction of your bowels such as a feeling of tightness in your stomach, stomach cramps, problems with passing stools (poos) or gas, and vomiting
    • Stop taking loperamide.
    • Tell your doctor immediately or ring HealthLine 0800 611 116


    • Loperamide may interact with a few medications and herbal supplements, so check with your doctor or pharmacist.
    • Check with our pharmacist before using over-the-counter medication such as laxatives (eg, Laxsol), or other diarrhoea medication (eg, Diastop).

    Learn more

    Loperamide New Zealand Formulary Patient Information

    FDA warns about OTC antacids, antidiarrheal med

    FDA is warning consumers about the risk of serious bleeding when using over-the-counter aspirin-containing antacid products to treat heartburn. The agency also issued a separate warning about loperamide (Imodium, Johnson & Johnson), saying that abuse or misuse of the product can cause serious heart problems that can lead to death.

    “These widely-used products already contain warnings about this bleeding risk on their labels; however, we are continuing to receive reports of this serious safety issue,” FDA said in a Drug Safety Communication about aspirin-containing antacids. “As a result, we will continue to evaluate this safety concern and plan to convene an advisory committee of external experts to provide input regarding whether additional FDA actions are needed.”

    Related: FDA warns about Cipro, other antibacterials

    Aspirin-containing antacids include Alka-Seltzer Original, Bromo Seltzer, Medique Medi Seltzer, Picot Plus Effervescent, Vida Mia Pain Relief, Winco Foods Effervescent Antacid and Pain Relief, Zee-Seltzer Antacid and Pain Reliever, along with their generic counterparts.

    Several OTC antacids that do not contain aspirin are available, FDA pointed out.

    While, all OTC products that contain NSAIDs, including aspirin-containing antacids, were required to add a warning about the risk of serious bleeding in 2009, FDA’s Adverse Event Reporting System (FAERS) database identified eight cases of serious bleeding events associated with these products after the warning was added.

    “All of these patients were hospitalized. Patients had underlying conditions such as the risk factors above that put them at greater risk for developing serious bleeding events,” FDA said.

    Related: FDA warns of joint pain for DPP-4 diabetes drugs

    In FDA’s warning about loperamide, the agency said that serious heart problems, including abnormal heart rhythms, may be increased when high doses of loperamide are taken with several kinds of medicines that interact with loperamide. These drugs include cimetidine (Tagamet HD) and ranitidine (Zantac).

    “The majority of reported serious heart problems occurred in individuals who were intentionally misusing and abusing high doses of loperamide in attempts to self-treat opioid withdrawal symptoms or to achieve a feeling of euphoria,” FDA said.

    In cases of abuse, individuals often use other drugs together with loperamide in attempts to increase its absorption and penetration across the blood-brain barrier and enhance its euphoric effects, according to FDA.

    “Health care professionals should be aware that use of higher-than-recommended doses of loperamide can result in serious cardiac adverse events. Consider loperamide as a possible cause of unexplained cardiac events including QT interval prolongation, Torsades de Pointes or other ventricular arrhythmias, syncope and cardiac arrest,” FDA said.

    Read more: FDA warns supplement firms over unapproved ingredient

    Loperamide (loperamide hydrochloride -HCI)

    Loperamide is an antidiarrheal active ingredient available in over-the-counter (OTC) medicines that treat the symptoms of diarrhea, including traveler’s diarrhea. Loperamide can be the only active ingredient in an anti-diarrheal medicine or it can be found in medicines that also treat symptoms such as gas.

    What is loperamide used to treat?

    • Diarrhea
    • Traveler’s diarrhea
    Common brands containing loperamide:
    • IMODIUM®
    • Store Brands (ex. Walmart’s “Equate” store brand or CVS Health store brand)

    How much loperamide can you take?

    Different types of products containing this active ingredient have different strengths. That’s why it is always important to read and follow the Drug Facts label. Most medicines warn against use of an active ingredient for longer than 7-10 days. Stop use and ask a doctor if symptoms persist.

    Safety guide for loperamide

    Loperamide is approved by the U.S. Food and Drug Administration (FDA) and is safe and effective when used according to the Drug Facts label. Do not exceed the maximum daily dose (8 mg per day for adults).

    Ask a healthcare provider before use if:

    • You are taking an antibiotic, antifungal, histamine 2 receptor antagonist, HIV medication or gemfibrozil (a cholesterol lowering drug).
    • You have a fever.
    • You have mucus in your stool.
    • You have a history of liver disease.
    • You are pregnant or breastfeeding.
    • You are taking other prescription and OTC medicines, vitamins, and other dietary supplements.
    • Talk to a healthcare provider before giving an OTC containing loperamide to a child under the age of 6.

    Do not use if:

    • You have ever had a rash or other allergic reaction to loperamide.
    • You have bloody or black stool.
    • Talk to a healthcare professional prior to use in children under the age of 6.

    Stop use and ask a doctor if:

    • Your symptoms get worse.
    • Your diarrhea lasts for more than two days.
    • Seek immediate medical attention if you experience any of the following: fainting; rapid heartbeat or irregular heart rhythm.
    • You get abdominal swelling or bulging.
    • You take too much. Immediately contact a healthcare provider or the poison control national helpline at 800.222.1222.

    What are the side effects of loperamide?

    • Taking higher than recommended doses of loperamide (maximum OTC dose is 8 mg per day for adults), including through abuse or misuse of the product, can cause serious heart problems that can lead to death.
    • The risk of serious heart problems may also be increased when high doses of loperamide are taken with medicines that interact with loperamide (see the FDA list of drugs that can potentially interact with loperamide here).
    • When using medicines containing loperamide, tiredness, drowsiness, or dizziness may occur.
    • You should use care when driving or operating machinery.

    Who should not take antidiarrhea and gas medications?

    Children aged 6 years or younger should not take antidiarrhea medications, unless your child’s doctor tells you so. Loperamide is the active ingredient in many over-the-counter (OTC) antidiarrhea medications (Imodium). Do not take medications that contain loperamide if you have a fever or if you have had an allergic reaction to it in the past. Do not take loperamide if you have black or bloody stools, which may be signs of a more serious problem.
    Bismuth subsalicylate, the active ingredient in Pepto-Bismol and Kaopectate, is another common ingredient in antidiarrhea medications. Do not take a medicine that contains bismuth subsalicylate if you are allergic to or are taking aspirin or if you have a bleeding problem such as hemophilia, an active bleeding ulcer, black or bloody stools, or Von Willebrand disease. Children younger than 12 years of age, as well as those between 12 and 18 years of age who have the flu or chickenpox, should not take medications containing bismuth subsalicylate or aspirin because it may increase the risk for Reye’s syndrome, a serious disease.

    OTC gas medications that contain simethicone may be given to children. When in doubt, call your child’s healthcare provider.

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