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Irritable bowel syndrome - Management
What should I consider when prescribing loperamide?
- Loperamide should be given in a dose of 2 mg to 4 mg, up to four times daily, for diarrhoea-predominant irritable bowel syndrome.
- Advise people to adjust the dose of antimotility drug according to response. The aim is to produce a soft, well-formed stool.
[Mertz, 2003; NICE, 2008]
- Adverse effects include abdominal cramps, dizziness, drowsiness, skin reactions (including urticaria), paralytic ileus, and abdominal bloating [BNF 55, 2008].
- There are no significant drug interactions with loperamide [ABPI Medicines Compendium, 2008; BNF 55, 2008].
- Do not use loperamide in people with conditions where inhibition of peristalsis should be avoided (e.g. abdominal distension), or in people with active ulcerative colitis or antibiotic-associated colitis.
- Loperamide should be used with caution in people with liver disease because of reduced first-pass metabolism [Micromedex, 2009].
- There are very limited data available of the effects of loperamide during pregnancy. Although the data available do not indicate a specific teratogenic risk, there is insufficient information to recommend its use in pregnancy [NTIS, 2008b].
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