Loperamide

Loperamide is an anti-diarrhoeal medicine that slows the gut so stools become less frequent and firmer; it relieves symptoms but does not treat the cause. This guide covers loperamide uses, how it works, dosage, side effects, precautions, drug interactions, use in pregnancy and breastfeeding and its approximate price in India.

At a Glance

Get urgent medical help if you faint, have chest pain, or have a racing or irregular heartbeat while taking loperamide. Also get help for blood in the stool, fever, severe abdominal pain or swelling, or signs of a serious allergic reaction.

What Is Loperamide?

Loperamide is a medicine that slows the movement of the gut. This gives the body more time to absorb water from stool, so stools become less frequent and firmer. It relieves the symptom of diarrhoea. It does not remove the cause, such as an infection or an inflammatory bowel condition.

How Loperamide Works

Loperamide acts on opioid receptors in the gut wall and reduces gut movement. At recommended doses it works mainly in the gut. At doses higher than recommended, it can affect the heart (see Side Effects and Precautions).

When Loperamide Is Used

The US prescription label copy we reviewed lists these uses

• Acute non-specific diarrhoea in patients 2 years and older.
• Chronic diarrhoea in adults with inflammatory bowel disease.
• Reducing the volume of ileostomy discharge.

Traveller’s diarrhoea appears on the US over-the-counter (OTC) label we reviewed, not on the prescription label. Uses and approved ages may differ for products sold in India. The manufacturer’s leaflet and your doctor’s advice apply.

Loperamide only relieves symptoms. With diarrhoea, drinking enough fluid matters. Severe diarrhoea can cause dehydration and loss of body salts. Seek medical care if you cannot keep fluids down or you show signs of dehydration.

Loperamide Dosage and How to Take It

Important: Indian dosing instructions could not be verified. We did not find a reliable, directly accessible official Indian source for loperamide dosing. The figures below come from US and UK sources. They are not instructions for Indian products and should not be assumed to apply to them. Follow your prescriber’s advice and the leaflet of the product you actually have.

US prescription label (adults, acute diarrhoea):

• 4 mg first, then 2 mg after each unformed stool.
• Maximum 16 mg per day.
• Improvement is usually seen within 48 hours. The label advises stopping if there is no improvement in 48 hours.
• The 16 mg/day prescription maximum is not an OTC limit or an Indian self-treatment limit.

US prescription label (chronic diarrhoea in adults):

Maintenance doses averaged 4–8 mg per day in the label copy. If there is no improvement after at least 10 days at 16 mg per day, symptoms are unlikely to be controlled by loperamide.

US OTC liquid (1 mg/5 mL, a different product):

Adults and children 12 and over take 4 teaspoonfuls, then 2 after each loose stool, up to 8 teaspoonfuls a day. Stop if symptoms last more than 2 days. Not for children under 6.

UK pharmacy self-treatment (NHS):

• 2 capsules (4 mg) first, then 1 capsule after each loose stool.
• Maximum 6 capsules a day.
• Use for 1–2 days. Do not take for more than 48 hours without medical advice.
• See a doctor if diarrhoea lasts 7 days.
• Not for children under 12 unless prescribed.

Children (US prescription label examples only):

• Loperamide is contraindicated under 2 years.
• The label copy gives examples such as 1 mg three times daily (2–5 years, 13–20 kg, liquid), 2 mg twice daily (6–8 years, 20–30 kg) and 2 mg three times daily (8–12 years, over 30 kg).
• The age bands in that copy overlap at 8 years. Children’s dosing depends on weight and the specific product, so it must be set by a doctor and must not be worked out from this article.

Side Effects of Loperamide

Common effects reported include constipation, abdominal discomfort or bloating, nausea, and dizziness or drowsiness. See the NHS side-effects page for its full list (reviewed 10 April 2024).

Serious effects, seek urgent help:

• Fainting, chest pain, or a racing or irregular heartbeat. The US label carries a boxed warning of Torsades de Pointes, cardiac arrest and death at higher-than-recommended doses, with misuse and abuse especially at 60 mg or more. Do not assume that heart risk applies only to overdose, and do not exceed the recommended dose.
• Severe abdominal pain or swelling, or no bowel movements with a swollen abdomen.
• Serious allergic reaction: swelling of the face, lips or throat, difficulty breathing, or a severe rash.
• Suspected overdose: get emergency medical help immediately.

Driving and alertness: Loperamide can cause tiredness, dizziness or drowsiness in some people. Do not drive or operate machinery until you know how it affects you, and avoid alcohol, which can make these effects worse.

Loperamide Precautions and Monitoring

Formal contraindications in the US prescription label copy:

• Children under 2 years.
• Known hypersensitivity to loperamide.
• Abdominal pain without diarrhoea.
• Acute dysentery (blood in stool with fever).
• Acute ulcerative colitis.
• Invasive bacterial enterocolitis.
• Pseudomembranous colitis (linked to antibiotics).

Situations that need medical assessment before or during use (precautions):

• Blood in the stool, fever, or severe abdominal pain.
• Diarrhoea that lasts longer than a day or two, or keeps returning.
• Liver disease: use with caution.
• Older adults, especially those taking QT-prolonging medicines: the label says to avoid it.
• Existing heart rhythm problems or heart disease.
• Dehydration or signs of it.

Loperamide Drug Interactions

Tell your doctor or pharmacist about all medicines you take. Findings in the label copy reflect changes in drug exposure, not proven clinical outcomes in every patient.

• CYP3A4 inhibitors (for example itraconazole), CYP2C8 inhibitors (for example gemfibrozil) and P-glycoprotein inhibitors (for example quinidine, ritonavir) can raise loperamide levels. Higher levels may increase heart-related risk.
• Saquinavir: its exposure fell by 54% when taken with loperamide.
• QT-prolonging medicines: the label warns against use together in elderly patients.
• NHS interaction page: it names clozapine and desmopressin. It also gives advice for people taking metformin, blood-pressure medicines or heart-failure medicines. Read that page for details.

This list is not complete. Do not start or stop any medicine without professional advice.

Loperamide in Pregnancy and Breastfeeding

• Pregnancy: the NHS (reviewed 10 April 2024) says loperamide is not usually recommended in pregnancy because information is limited. Speak to a doctor or pharmacist before use.
• Breastfeeding: the NHS says it is OK, because only tiny amounts pass into breast milk.
• The US label text we read had no pregnancy or breastfeeding statements. A missing statement is not evidence of safety or harm.

Loperamide Brands, Strengths and Approximate Price in India

Each row below comes from one listing only. Prices change and stock is not guaranteed. Check with your pharmacist.

The two Lomofen Plus entries are separate listings from different dates, and their prices are not merged or averaged. Neither is confirmed as current. We did not publish a price range. Both listings describe Lomofen Plus as loperamide 2 mg, but the “Plus” in the name suggests there may be another ingredient. Check the product pack.

How HealthPil Can Help

HealthPil can help you understand your medicines, compare brands and prices, and prepare questions for your doctor or pharmacist. 

You can consult a doctor online with HealthPil before starting, stopping or changing this medicine.