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Loperamide

Loperamide, usually as hydrochloride, is a drug effective against diarrhea resulting from gastroenteritis or inflammatory bowel disease. In most countries it is available generically under brand names such as Lopex®, Imodium®, Dimor® and Pepto® Diarrhea Control. more...

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Mode of action

Loperamide is an opioid receptor agonist and acts on the mu opioid receptors in the myenteric plexus large intestines; it does not affect the central nervous system like other opioids.

It works by decreasing the activity of the myenteric plexus which decreases the motility of the circular and longitudinal smooth muscles of the intestinal wall. This increases the amount of time substances stay in the intestine, allowing for more water to be absorbed out of the fecal matter. Loperamide also decreases colonic mass movements and suppresses the gastrocolic reflex.

Loperamide does not cross the blood-brain barrier and has no analgesic properties or addictive potential. Tolerance in response to long-term use has not been reported.

Contraindications

Treatment should be avoided in the presence of fever or if the stool is bloody. Treatment is not recommended for patients who could suffer detrimental effects from rebound constipation. If there is a suspicion of diarrhea associated with organisms that can penetrate the intestinal walls, such as E. coli O157:H7 or salmonella, loperamide is contraindicated.

Side-effects

Side effects can include the following: drowsiness, constipation, abdominal pain or discomfort, dry mouth, fatigue, and in rare cases toxic megacolon.

Read more at Wikipedia.org

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Traveler's diarrhea: what you should know
From American Family Physician, 6/1/05

What is traveler's diarrhea?

Traveler's diarrhea can occur when you go to another country (usually a developing country). It also can occur shortly after you get home.

Who gets traveler's diarrhea and why?

Anyone can get traveler's diarrhea. About one half of all people traveling from developed countries to developing countries get it. Germs in food or water (from unclean conditions) cause this diarrhea.

How can I tell if I have traveler's diarrhea?

You probably have traveler's diarrhea if you have at least three loose stools in 24 hours. You also will have one or more of the following symptoms: fever, vomiting, stomach cramps, or bloody stools. You also can have a milder case with sudden watery diarrhea and stomach cramps.

How is traveler's diarrhea treated?

Traveler's diarrhea often is treated with antibiotics. You also can take loperamide (brand name: Imodium), but don't take it without an antibiotic if you have bloody diarrhea. Children, pregnant women, older adults, and other people who get dehydrated easily should drink rehydration solutions. You can buy packets of rehydration salts (to be mixed with safe water) at camping/outdoor stores or drug stores. If your child has a fever higher than 102oF, is dehydrated, has blood in the stool, or vomits several times, he or she should see a doctor right away.

What can I expect?

If you don't treat traveler's diarrhea, it usually will go away in four to five days. But treatment with an antibiotic and loperamide often can cure you within 24 hours. If you are not better after taking antibiotics, talk to your doctor.

How can I prevent traveler's diarrhea?

See your doctor four to six weeks before traveling out of the country. Be careful about what you eat and drink while you are away. Unsafe foods include salads, unpeeled fruits, raw or undercooked meats and seafood, and unpasteurized dairy products. Don't drink tap water. Don't use ice unless you're sure it's made from purified water. Bottled water is probably safe, but be sure the cap and seal are not broken. Don't eat food from street food stands.

Where can I get more information?

You can find more information about traveler's diarrhea at the Travelers' Health section of the Centers for Disease Control and Prevention Web site (http://www.cdc.gov/travel/diarrhea.htm).

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