Brands, Medical Use, Clinical Data
Drug Category
Dosage Forms
Brands / Synonyms
Apo-Loperamide; Diarr-Eze; Imodium; Imodium A-D; Imodium A-D Caplets; Ioperamide; Kaopectate II; Loperacap; Loperamida [INN-Spanish]; Loperamide HCL; Loperamidum [INN-Latin]; Maalox Anti-Diarrheal; Nu-Loperamide; Pepto Diarrhea Control; PMS-Loperamide; Rho-Loperamide
Indications
For the control and symptomatic relief of acute nonspecific diarrhea and of chronic diarrhea associated with inflammatory bowel disease or gastroenteritis. Also used for reducing the volume of discharge from ileostomies.
Pharmacology
Loperamide is a synthetic anti-diarrheal indicated for the control and symptomatic relief of acute nonspecific diarrhea and of chronic diarrhea associated with inflammatory bowel disease. Loperamide is also indicated for reducing the volume of discharge from ileostomies. In man, Loperamide prolongs the transit time of the intestinal contents. It reduces the daily fecal volume, increases the viscosity and bulk density, and diminishes the loss of fluid and electrolytes. Tolerance to the antidiarrheal effect has not been observed. 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 specifically 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.
Mechanism of Action
In vitro and animal studies show that Loperamide acts by slowing intestinal motility and by affecting water and electrolyte movement through the bowel. Loperamide inhibits peristaltic activity by a direct effect on the circular and longitudinal muscles of the intestinal wall. It is a non-selective calcium channel blocker and binds to opioid mu-receptors. Evidence also suggests that at higher concentrations it binds to NMDA receptors and to calmodulin.
Absorption
Not significantly absorbed from the gut
Toxicity
Oral, mouse: LD50 = 105 mg/kg. Symptoms of overdose include constipation, drowsiness, lethargy, and nausea.
Biotrnasformation / Drug Metabolism
Hepatic
Contraindications
Loperamide hydrochloride is contraindicated in patients with known hypersensitivity to the drug and in those in
whom constipation must be avoided.
Drug Interactions
There was no evidence in clinical trials of drug interactions with concurrent medications.
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