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How does loperamide work?

Loperamide slows the movement of contents through the bowel and reduces the frequency of diarrhoea. During diarrhoea, fluid is lost from the body. Fluids should be replaced by drinking regularly throughout the day.

Cautions

Checks before using loperamide for diarrhoea in IBS

It is important to be sure that your symptoms are caused by IBS and not something more serious. You must have a previous confirmed diagnosis of IBS.

Check with your GP before using loperamide if any of the following applies:

• Over 40 years old with first time IBS symptoms, changed symptoms including a new change in bowel habit lasting over 2 weeks.
• New symptoms especially bloating in women.
• New symptoms of blood in your stool or motions.
• Feeling nauseous or vomiting or loss of appetite.
• Losing weight without dieting.
• Pale and tired.
• Running a high temperature (fever).
• Travelled abroad recently.

Loperamide should not be taken:

• If you have liver disease.
• Where there has been prolonged constipation before diarrhoea starts.
• Where the diarrhoea contains blood and there is a high fever.

Do not take loperamide if pregnant or breastfeeding.

Other medications

Some other medications may slightly increase the dose of loperamide in your system:

• Ritonavir (for HIV).
• Itraconazole or ketoconazole (for fungal infections).
• Gemfibrozil (for high cholesterol).

Also see the manufacturer's patient information leaflet.

Side effects of loperamide

There may be no side effects.

Possible side effects include feeling sick (nausea), constipation, and headache.

Loperamide occasionally causes drowsiness or dizziness. If affected you should not drive, cycle, or operate machinery.

Further information on possible side effects can be found in the manufacturer's patient information leaflet.

How to take loperamide 2mg for IBS

• Take 2 capsules straight away.
• Then take one capsule after each episode of diarrhoea for up to 48 hours.
• The maximum number of capsules in a day is 6 tablets (total 12mg). The usual amount is 3-4 capsules (6-8mg) daily.

The aim is to adjust to the amount of loperamide which allows a regular, soft but well formed, comfortable stool.

If there is no improvement after 48 hours, it should be stopped and a doctor consulted. Loperamide can be used for up to 2 weeks for repeated attacks.

Other measures to help symptoms of IBS

Diarrhoea and bloating - reduce insoluble fibre like bran, wholegrain bread, and brown rice. Reduce caffeine, alcohol, fizzy drinks, and gas-producing foods like beans and cabbage.

Constipation - try adding more soluble fibre like oats and linseed, or soluble fibre supplements like Fybogel (ispaghula). Increase the soluble fibre gradually or bloating and wind may get worse. It may take several weeks for optimal benefits.

Make sure that you drink plenty of fluids.

Regular physical activity is also helpful for the bowels. Aim for 30 minutes of moderate activity at least 5 days per week.

For further information see NHS - IBS - Diet, lifestyle and medicines.