Dosing & Uses
Diarrhea/Flatulence
After each loose bowel movement: 2 tablets once initially, then 1 tab/dose with each subsequent loose stool up to 4 tab/day
Diarrhea/Flatulence
<6 years: Safety and efficacy not established
6-8 years: 1 tablet once initially, then one-half tablet/dose, up to 2 tablets/day
9-12 years: 1 tablet once initially, then one-half tablet/dose, up to 3 tablets/day
≥ 12 years: After each loose bowel movement: 2 tablets once initially, then 1 tab/dose with each subsequent loose stool up to 4 tab/day
Diarrhea/Flatulence
After each loose bowel movement: 2 tablets once initially, then 1 tab/dose with each subsequent loose stool up to 4 tab/day
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (38)
- amisulpride
amisulpride and loperamide both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.
- anagrelide
anagrelide and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- artemether
artemether and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- artemether/lumefantrine
artemether/lumefantrine and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine
asenapine and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine transdermal
asenapine transdermal and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- bedaquiline
bedaquiline and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine
buprenorphine and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine buccal
buprenorphine buccal and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine subdermal implant
buprenorphine subdermal implant and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine transdermal
buprenorphine transdermal and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- ceritinib
ceritinib and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- chloroquine
chloroquine and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- citalopram
citalopram and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- clarithromycin
clarithromycin and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- clozapine
clozapine and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- crizotinib
crizotinib and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- desflurane
desflurane and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- eluxadoline
loperamide, eluxadoline. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that cause constipation. Increases risk for constipation related serious adverse reactions. Loperamide may be used occasionally for acute management of severe diarrhea but avoid chronic use. Discontinue loperamide immediately if constipation occurs.
- entrectinib
entrectinib and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- erdafitinib
erdafitinib will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.
- eribulin
eribulin and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- fentanyl
fentanyl, loperamide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- fentanyl intranasal
fentanyl intranasal, loperamide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- fentanyl transdermal
fentanyl transdermal, loperamide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- fentanyl transmucosal
fentanyl transmucosal, loperamide. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- fexinidazole
fexinidazole and loperamide both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
fexinidazole will increase the level or effect of loperamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates. - infigratinib
simethicone will decrease the level or effect of infigratinib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. If use with an acid-reducing agent cannot be avoided, administer infigratinib 2 hr before and after administration of a locally-acting antacid.
- isoflurane
isoflurane and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- lasmiditan
lasmiditan increases levels of loperamide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
- lefamulin
lefamulin and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- oxaliplatin
oxaliplatin and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- quinidine
quinidine will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
- sevoflurane
sevoflurane and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
- sotorasib
sotorasib will decrease the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.
simethicone will decrease the level or effect of sotorasib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. If use with an acid-reducing agent cannot be avoided, administer sotorasib 4 hr before or 10 hr after administration of a locally-acting antacid. - tepotinib
tepotinib will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.
- tetrabenazine
tetrabenazine and loperamide both increase QTc interval. Avoid or Use Alternate Drug.
Monitor Closely (60)
- albuterol
albuterol and loperamide both increase QTc interval. Use Caution/Monitor.
- alfuzosin
alfuzosin and loperamide both increase QTc interval. Use Caution/Monitor.
- amiodarone
amiodarone will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- apomorphine
apomorphine and loperamide both increase QTc interval. Use Caution/Monitor.
- arformoterol
arformoterol and loperamide both increase QTc interval. Use Caution/Monitor.
- aripiprazole
aripiprazole and loperamide both increase QTc interval. Use Caution/Monitor.
- atomoxetine
atomoxetine and loperamide both increase QTc interval. Use Caution/Monitor.
- atorvastatin
atorvastatin will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- berotralstat
berotralstat will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.
- bosutinib
bosutinib increases levels of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- clarithromycin
clarithromycin will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- clotrimazole
clotrimazole will decrease the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- crizotinib
crizotinib increases levels of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- cyclosporine
cyclosporine will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- dasatinib
dasatinib and loperamide both increase QTc interval. Use Caution/Monitor.
- degarelix
degarelix and loperamide both increase QTc interval. Use Caution/Monitor.
- deutetrabenazine
deutetrabenazine and loperamide both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).
- dolasetron
dolasetron and loperamide both increase QTc interval. Use Caution/Monitor.
- donepezil
donepezil and loperamide both increase QTc interval. Use Caution/Monitor.
- doxepin
doxepin and loperamide both increase QTc interval. Use Caution/Monitor.
- dronedarone
dronedarone will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- efavirenz
efavirenz and loperamide both increase QTc interval. Use Caution/Monitor.
- elagolix
elagolix will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- eliglustat
eliglustat increases levels of loperamide by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.
eliglustat and loperamide both increase QTc interval. Use Caution/Monitor. - erythromycin base
erythromycin base will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- erythromycin lactobionate
erythromycin lactobionate will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- erythromycin stearate
erythromycin stearate will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- felodipine
felodipine will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- fosphenytoin
fosphenytoin will decrease the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- fostamatinib
fostamatinib will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Concomitant use of fostamatinib may increase concentrations of P-gp substrates. Monitor for toxicities of the P-gp substrate drug that may require dosage reduction when given concurrently with fostamatinib.
- fostemsavir
loperamide and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
- gemifloxacin
gemifloxacin and loperamide both increase QTc interval. Use Caution/Monitor.
- gilteritinib
gilteritinib and loperamide both increase QTc interval. Use Caution/Monitor.
- glecaprevir/pibrentasvir
glecaprevir/pibrentasvir will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- granisetron
granisetron and loperamide both increase QTc interval. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and loperamide both increase QTc interval. Use Caution/Monitor.
- indinavir
indinavir will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- istradefylline
istradefylline will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.
- itraconazole
itraconazole and loperamide both increase QTc interval. Use Caution/Monitor.
- ivacaftor
ivacaftor increases levels of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.
- ketoconazole
ketoconazole will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- lapatinib
lapatinib will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- lenacapavir
lenacapavir will increase the level or effect of loperamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.
- levoketoconazole
levoketoconazole will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- lithium
lithium and loperamide both increase QTc interval. Use Caution/Monitor.
- lomitapide
lomitapide increases levels of loperamide by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing dose when used concomitantly with lomitapide.
- lonafarnib
lonafarnib will increase the level or effect of loperamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Loperamide is contraindicated in patients aged <2 years; when lonafarnib is coadministered with loperamide, do not exceed loperamide 1 mg qDay when first coadministered; slowly increase loperamide dosage with caution in accordance with its approved product labeling.
lonafarnib will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Lonafarnib is a weak P-gp inhibitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Reduce P-gp substrate dose if needed. - loratadine
loratadine will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- lovastatin
lovastatin will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- metoclopramide intranasal
loperamide will decrease the level or effect of metoclopramide intranasal by Other (see comment). Use Caution/Monitor. Coadministration of metoclopramide intranasal with drugs that impair GI motility may decrease systemic absorption of metoclopramide. Monitor for reduced therapeutic effect.
- mirtazapine
mirtazapine and loperamide both increase QTc interval. Use Caution/Monitor.
- nefazodone
nefazodone will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- nicardipine
nicardipine will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- nifedipine
nifedipine will decrease the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- nilotinib
nilotinib will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- olanzapine
olanzapine and loperamide both increase QTc interval. Use Caution/Monitor.
- osilodrostat
osilodrostat and loperamide both increase QTc interval. Use Caution/Monitor.
- pexidartinib
simethicone will decrease the level or effect of pexidartinib by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate pexidartinib by 2 hr before or after taking a locally-acting antacid.
- phenobarbital
phenobarbital will decrease the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
Minor (2)
- gemfibrozil
gemfibrozil will increase the level or effect of loperamide by decreasing metabolism. Minor/Significance Unknown.
- itraconazole
itraconazole will increase the level or effect of loperamide by Other (see comment). Minor/Significance Unknown. Monitor ECG when itraconazole is coadministered with loperamide (dose >16mg/day).
Adverse Effects
Frequency Not Defined
Dizziness
Fatigue
Headache
Abdominal pain
Dry mouth
Nausea
Diarrhea
Vomiting
Pancreatitis
Warnings
Contraindications
Hypersensitivity, bloody diarrhea, high fever, infectious diarrhea, pseudomembranous colitis
Patients in whom constipation must be avoided
Abdominal pain without diarrhea
Avoid use as primary therapy with acute dysentery (bloody stools and high fever, acute ulcerative colitis, bacterial enterocolitis [caused by Salmonella, Shigella, and Campylobacter), pseudomembranous colitis associated with antibiotic use)
Age <2 years
Cautions
Chewable tab should be chewed thoroughly before swallowing
loperamide
- May cause drowsiness or dizziness, which may impair physical abilities to operate heavy machinery or tasks requiring mental alertness
- Ask healthcare professional if mucus present in stool or history of abnormal heart rhythm
- Hypersensitivity reactions reported, including anaphylaxis, rash, urticaria, and rare cases of Steven’s Johnson syndrome or toxic epidermal necrolysis
- Discontinue if no improvement seen within 48 hr in patients with acute diarrhea, symptoms worsen, or abdominal swelling or bulging develops
- Discontinue promptly if constipation, abdominal pain or distention, blood in stool, or ileus develops; do not use when peristalsis inhibition should be avoided (ie, due to potential for ileus, megacolon, or toxic megacolon)
- Discontinue therapy if symptoms of abdominal distention occur in patients with AIDS; cases of toxic megacolon reported with infectious colitis, resulting from viral or bacterial pathogens
- Taking more than directed can cause serious heart problems or death
- Use with caution in patients with hepatic impairment due to reduced first-pass metabolism; monitor for signs of CNS toxicity
- Use of higher than recommended doses or abuse of loperamide can result in serious cardiac adverse events, including QT interval prolongation, Torsades de Pointes, or other ventricular arrhythmias, syncope, and cardiac arrest; 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, inhibit loperamide metabolism, and enhance its euphoric effects
simethicone
- Can cause false-negative gastric guaiac test
Pregnancy & Lactation
Pregnancy category: B (loperamide); C (simethicone)
Lactation: Unknown if distributed in to breast milk, use caution
Pregnant or breastfeeding patients should seek advice of health professional before using OTC drugs
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Slows intestinal motility by direct effects on circular & longitudinal muscle (loperamide); changes surface tension of gas bubbles, causing collapse of foam bubbles, thus allow easier passage (simethicone)
