Loperamide Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Diarrhea - Acute

Tablets, capsules, and liquid:
Initial: 4 mg orally after the first loose stool, then
Maintenance: 2 mg after each loose stool, not to exceed 16 mg in any 24-hour period. Clinical improvement is usually observed within 48 hours.
Chewable tablets:
Initial: 4 mg after the first loose stool, then
Maintenance: 2 mg after each subsequent loose stool, but not exceeding 8 mg in 24 hours.

Usual Adult Dose for Diarrhea - Chronic

Tablets, capsules, and liquid:
Initial: 4 mg orally once followed by 2 mg orally after each loose stool, not to exceed 16 mg in any 24-hour period.
Maintenance: The average daily maintenance dosage is 4 to 8 mg. Clinical improvement is usually observed within 10 days. If clinical improvement is not observed at a maximum dosage of 16 mg for duration of 10 days, symptoms are unlikely to be controlled by further administration.

Usual Pediatric Dose for Diarrhea - Acute

2 to 6 years (13 to 20 kg):
Liquid formulation only to be used in this age group.
Initial: 1 mg orally 3 times a day for the first day, then
Maintenance: 0.1 mg/kg/dose after each loose stool, but not exceeding initial dose.

6 to 8 years (20 to 30 kg):
Tablets, capsules, and liquid:
Initial: 2 mg orally twice a day for the first day, then
Maintenance: 0.1 mg/kg/dose after each loose stool, but not exceeding initial dose.
Chewable tablets:
Initial: 2 mg orally after the first loose stool, then
Maintenance: 1 mg orally after each subsequent loose stool, but not exceeding 4 mg in 24 hours.

8 to 12 years (greater than 30 kg):
Tablets, capsules, and liquid:
Initial: 2 mg orally 3 times a day for the first day, then
Maintenance: 0.1 mg/kg/dose after each loose stool, but not exceeding initial dose.
Chewable tablets:
Initial: 2 mg orally after the first loose stool, then
Maintenance: 1 mg orally after each subsequent loose stool, but not exceeding 6 mg in 24 hours.

12 to 18 years:
Tablets, chewable tablets, capsules, and liquid:
Initial: 4 mg after the first loose stool, then
Maintenance: 2 mg after each subsequent loose stool, but not exceeding 8 mg in 24 hours.

Usual Pediatric Dose for Diarrhea - Chronic

less than 2 years:
Therapeutic dose for the treatment of chronic diarrhea has not been established for this patient population.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Patients with liver dysfunction should use loperamide with caution and should be closely monitored for signs of CNS toxicity

Dose Adjustments

Once diarrhea is controlled, the daily dose should be reduced to the lowest effective maintenance dose.

Precautions

Loperamide is considered contraindicated in patients with abdominal pain in the absence of diarrhea. Loperamide is not recommended as primary therapy in patients with acute dysentery characterized by blood in the stools and high fever, acute ulcerative colitis, bacterial enterocolitis caused by invasive organisms including Salmonella, Shigella, and Campylobacter, and in patients with pseudomembranous colitis associated with the use of broad-spectrum antibiotics. Loperamide is not recommended in infants less than 24 months of age.

Fluids and electrolytes should be replaced as necessary.

The use of loperamide is not recommended in patients in whom peristalsis is to be avoided due to the possible risk of significant sequelae (including ileus, megacolon, and toxic megacolon). Loperamide should be discontinued immediately in patients who develop constipation, abdominal distention, or ileus.

Whenever indicated and/or appropriate, the underlying etiology of the diarrhea should be determined and treated appropriately.

There are isolated reports of toxic megacolon in AIDS patients with infectious colitis (both viral and bacterial pathogens) treated with loperamide. Therefore, it is recommended to discontinue loperamide therapy in AIDS patients at the first sign of possible abdominal distention.

There are rare reports of allergic reactions including anaphylaxis and anaphylactic shock. Loperamide therapy should be stopped and a physician notified if symptoms get worse, diarrhea lasts for more than 48 hours, if blood is observed in the stools, or abdominal swelling or bulging occurs.

Caution is recommended in patients with hepatic dysfunction. In addition, these patients should be monitored closely for signs of central nervous system (CNS) toxicity.

Loperamide should be used with special caution in young children because of the greater variability of response in this age group. Dehydration, particularly in younger children, may further influence the variability of response to loperamide.

Loperamide may impair the mental abilities necessary for potentially hazardous tasks such as driving a car or operating machinery.

Dialysis

Data not available

Other Comments

Maximum recommended dose for adults is 16 mg per day.

The duration of treatment for acute diarrhea generally does not exceed 48 hours.

Therapy should be accompanied by fluid and electrolyte replacement as needed.

Tolerance to the antidiarrheal effect of loperamide has not been reported.

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