Loperamide chemical structure
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Imodium

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.

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Solutions for an upset stomach
From Advocate, The, 11/8/05

For HIVers already experiencing gastrointestinal side effects from their antiretroviral drugs, the prospect of "traveler's tummy" may be enough to put those vacation plans on hold. But according to AIDS experts, you can minimize potential problems via:

PREVENTION: This could mean changing your antiretroviral regimen before you leave to include medications with fewer gastrointestinal side effects, and avoiding foods and drinks that may trigger digestive disturbances, like spicy dishes, greasy foods, dairy products, chocolate, coffee, soft drinks, alcohol, and wine. Raw and undercooked foods also can cause bacterial or parasitic infections, as can tap water in some foreign countries.

BE MINDFUL OF DRUG INTERACTIONS: If you do experience heartburn or upset stomach, your first instinct may be to stock up on antacids or antidiarrheal medications. But HIVers must be cautious: Many of these drugs interact badly with anti-HIV medications, boosting the risk for drug resistance and treatment failure, says Tom Barrett, MD, an HIV specialist at Chicago's Howard Brown Health Center. Alka-Seltzer, Maalox, Tums, and Rolaids can interfere with the stomach's absorption of Agenerase, Crixivan, Rescriptor, and Reyataz, while Axid, Pepcid, Tagamet, and Zantac should be entirely avoided by those taking Crixivan, Rescriptor, and Reyataz. Antidiarrheals like Imodium, Kaopectate, and fiber supplements are generally safe for HIVers, as are prescription anti-nausea medications, says Judith Feinberg, MD, former chair of the American Academy of HIV Medicine.

WHEN ALL ELSE FALLS: Try a "BRAT" diet--bananas, rice, applesauce, and toast, advise some health care providers.

COPYRIGHT 2005 Liberation Publications, Inc.
COPYRIGHT 2005 Gale Group

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