Loperamide is acts directly on intestinal muscles to inhibit peristalsis and prolongs transit time enhancing fluid and electrolyte movement through intestinal mucosa, reduces fecal volume, increases viscosity, and diminishes fluid electrolyte loss, demonstrates antisecretory activity exhibits peripheral action.

Indications: Symptomatic treatment of acute diarrhea, adjunct to rehydration in acute and chronic diarrhoea in adults and in adults and in acute diarrho4ea in children over 4 years of age.

Cautions: liver disease; pregnancy.

Contra-indications: Children below 4 years. Diarrhoea of ulcerative colitis or antibiotic-associated colitis.

Treatment should be avoided in the patients with acute dysentery, which is characterised with blood in stools and highfever.. 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 or salmonella, loperamide is contraindicated.

Side effect: drowsiness, dizziness, fatigue, sedation, constipation, abdominal pain or discomfort, dry mouth, and nausea, rash, toxic epidermal necrolysis.

Dose: Acute diarrhoea, 4 mg initially followed by 2 mg after each loose stool for up to 5 days, usual dose 6-8 mg daily, max. 16 mg daily, children under 4 years not recommended, Child, 4-8 years, 1 mg 3- 4 times daily for up to 3 days only, 9-12 years, 2 mg 4 times daily for up to 5 days.

Chronic diarrhoea in adults, 4-8 mg daily in divided doses initially and then if necessary adjusted according to response and given twice daily for maintenance. Max. 16 mg daily.