Imodium (Loperamide Hydrochloride)
Also sold as: Imodium, Lopamide, Eldoper, Lomofen, Lomotil (different — contains atropine)
Pregnancy
Cat C
Lactation
Caution
Schedule
OTC
Forms
Capsule 2mg +2
Indications
- Acute non-specific diarrhea
- Traveller's diarrhea
- Chronic diarrhea (IBS-D, functional diarrhea)
- Reduction of ileostomy/colostomy output
Adult Dosing
Acute diarrhea
4 mg PO initially, then 2 mg after each loose stool
Max 5 days
Max 16 mg/day (OTC); 8 mg/day unless medically supervised
Chronic diarrhea
4-8 mg/day in divided doses, adjusted to response
Titrate to 1-2 stools/day
Ileostomy/colostomy
4-8 mg/day in divided doses
Pediatric Dosing
AVOID in children <2 years (risk of ileus, CNS toxicity). Do NOT use for infectious diarrhea with high fever or bloody stools in children.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any | No adjustment — not renally eliminated |
Hepatic Adjustment
Use with caution in severe hepatic impairment — CNS toxicity risk (opioid effect)
Pregnancy & Lactation
Pregnancy: Category C
Use only if clearly necessary; avoid in 1st trimester. Dehydration from diarrhea is greater risk than loperamide. ORS is first-line.
Lactation: Caution
Small amounts in breast milk. Short-term use generally considered acceptable.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| P-gp inhibitors (quinidine, ritonavir) | Increased loperamide CNS penetration — CNS/respiratory depression | Major |
| QT-prolonging drugs | Additive QT prolongation at high doses | Moderate |
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Side Effects
Common
- Constipation
- Abdominal cramps
- Nausea
- Dizziness
- Dry mouth
Serious / Discontinue If
- Toxic megacolon (in IBD or C. difficile — CONTRAINDICATED)
- CNS and respiratory depression (massive overdose; rare at therapeutic doses)
- QT prolongation / Torsades (high doses, with P-gp inhibitors)
Contraindications
- Bloody diarrhea / fever (suggests infectious colitis — needs antibiotics not loperamide)
- Acute dysentery
- C. difficile colitis
- Inflammatory bowel disease (active flare)
- Children < 2 years
- Ileus or bowel obstruction
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Imodium 2mg | J&J (Janssen) | 10 cap ₹48 |
| Lopamide 2mg | Wockhardt | 10 tab ₹35 |
| Eldoper 2mg | Elder | 10 cap ₹38 |
| Lomofen 2mg | Sun Pharma | 10 cap ₹32 |
Patient Counseling Points
- DO NOT use for diarrhea with fever, blood or mucus in stools — see a doctor immediately
- Drink plenty of ORS / fluids alongside to prevent dehydration
- Stop if no improvement after 48 hours of acute diarrhea — see doctor
- Do not exceed maximum dose — cardiac side effects at high doses
- DO NOT give to children under 2 years
Stop Googling drug references mid-consultation
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Clinically reviewed by: Dr. Rajesh Nair, DM (Gastroenterology), Senior Consultant
Last reviewed: 2026-04-01
References
- BNF — Loperamide
- ACG Acute Diarrhea Guidelines
- WHO ORS and Antidiarrheal Guidelines
- FDA Loperamide Safety Communication 2016