Loperamide Hydrochloride interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

  What to do: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

  4 sources

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):

Conditions

Conditions in which Loperamide Hydrochloride needs care, as documented in this source.

• Dysentery

  Major

  The use of drugs with antiperistaltic activity (primarily antidiarrheal and antimuscarinic agents, but also antispasmodic agents such as dicyclomine or oxybutynin at high dosages) is contraindicated in patients with diarrhea due to pseudomembranous enterocolitis or enterotoxin-producing bacteria. These drugs may prolong and/or worsen diarrhea associated with organisms that invade the intestinal mucosa, such as toxigenic E. coli, Salmonella and Shigella, and pseudomembranous colitis due to broad-spectrum antibiotics. Other symptoms and complications such as fever, shedding of organisms and extraintestinal illness may also be increased or prolonged. In general, because antiperistaltic agents decrease gastrointestinal motility, they may delay the excretion of infective gastroenteric organisms or toxins and should be used cautiously in patients with any infectious diarrhea, particularly if accompanied by high fever or pus or blood in the stool. Some cough and cold and other combination products may occasionally include antimuscarinic agents for their drying effects and may, therefore, require careful selection when necessary.

  6 sources

  1. Brown JW "Toxic megacolon associated with loperamide therapy." JAMA 241 (1979): 501-2
  2. Walley T, Milson D "Loperamide related toxic megacolon in Clostridium difficile colitis." Postgrad Med J 66 (1990): 582
  3. "Product Information. Imodium (loperamide)." Janssen Pharmaceuticals (2001):
  4. Marshall WF Jr, Rosenthal P, Merritt RJ "Atropine therapy and paralytic ileus in an infant." J Pediatr Gastroenterol Nutr 9 (1989): 532-4
  5. "Lomotil for diarrhea in children." Med Lett Drugs Ther 17 (1975): 104
  6. "Product Information. Atropine Sulfate (atropine)." ESI Lederle Generics (2022):

• Liver Failure

  Moderate

  Therapy with antiperistaltic agents should be administered with extreme caution in patients with hepatorenal disease or abnormal liver enzymes. Antiperistaltic agents are metabolized by the liver (diphenoxylate to an active form) and primarily excreted in the feces. Hepatic coma can be precipitated.

  3 sources

  1. "Product Information. Imodium (loperamide)." Janssen Pharmaceuticals (2001):
  2. "Product Information. Kaopectate (attapulgite)." Pharmacia and Upjohn (2001):
  3. "Product Information. Pepto-Bismol (bismuth subsalicylate)." Procter and Gamble Pharmaceuticals (2001):

• Megacolon, Toxic

  Moderate

  Decreased intestinal motility and prolonged transit time have resulted in toxic megacolon in patients with acute ulcerative colitis. Paralytic ileus has also occurred. Antiperistaltic agent GI motility and prolongs transit time and therapy should be administered cautiously in these patients.

  4 sources

  1. "Product Information. Imodium (loperamide)." Janssen Pharmaceuticals (2001):
  2. "Product Information. Kaopectate (attapulgite)." Pharmacia and Upjohn (2001):
  3. "Product Information. Pepto-Bismol (bismuth subsalicylate)." Procter and Gamble Pharmaceuticals (2001):
  4. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division (1998):

• Water-Electrolyte Imbalance

  Moderate

  Diarrhea can cause severe dehydration and electrolyte imbalance. Fluid accumulation within the GI track due to antiperistaltic-associated decrease in peristalsis can further aggravate dehydration and electrolyte imbalance. Antiperistaltic agents should be administered cautiously in patients with electrolyte imbalance and rehydration and electrolyte replacement should be initiated prior to initiation of therapy.

  3 sources

  1. "Product Information. Imodium (loperamide)." Janssen Pharmaceuticals (2001):
  2. "Product Information. Kaopectate (attapulgite)." Pharmacia and Upjohn (2001):
  3. "Product Information. Pepto-Bismol (bismuth subsalicylate)." Procter and Gamble Pharmaceuticals (2001):