Editing Loperamide (section)

==Side effects==
[[Adverse drug reaction]]s most commonly associated with loperamide are constipation (which occurs in 1.7–5.3% of users), dizziness (up to 1.4%), nausea (0.7–3.2%), and abdominal cramps (0.5–3.0%).<ref name=ReferenceA>{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2005/017694s050lbl.pdf |title=Imodium label |publisher=U.S. [[Food and Drug Administration]] (FDA) |access-date=21 April 2014 |url-status=live |archive-url=https://web.archive.org/web/20140423055633/http://www.accessdata.fda.gov/drugsatfda_docs/label/2005/017694s050lbl.pdf |archive-date=23 April 2014 }}</ref> Rare, but more serious, side effects include toxic megacolon, [[paralytic ileus]], [[angioedema]], anaphylaxis/allergic reactions, [[toxic epidermal necrolysis]], [[Stevens–Johnson syndrome]], [[erythema multiforme]], [[urinary retention]], and [[heat stroke]].<ref>{{cite web|url=https://online.epocrates.com/noFrame/showPage.do;jsessionid=FB4C4C42205138677A3F9E475E6C6299?method=drugs&MonographId=44&ActiveSectionId=5|title=loperamide adverse reactions|access-date=14 May 2016|archive-url=https://web.archive.org/web/20181101071123/https://online.epocrates.com/noFrame/showPage.do;jsessionid=FB4C4C42205138677A3F9E475E6C6299?method=drugs&MonographId=44&ActiveSectionId=5|archive-date=1 November 2018|url-status=dead}}</ref> The most frequent symptoms of loperamide overdose are drowsiness, vomiting, and abdominal pain, or burning.<ref>{{cite journal | vauthors = Litovitz T, Clancy C, Korberly B, Temple AR, Mann KV | title = Surveillance of loperamide ingestions: an analysis of 216 poison center reports | journal = Journal of Toxicology. Clinical Toxicology | volume = 35 | issue = 1 | pages = 11–9 | date = 1997 | pmid = 9022646 | doi = 10.3109/15563659709001159 }}</ref> High doses may result in heart problems such as [[abnormal heart rhythm]]s.<ref>{{cite web|title=Safety Alerts for Human Medical Products - Loperamide (Imodium): Drug Safety Communication - Serious Heart Problems With High Doses From Abuse and Misuse|url=https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm505303.htm|website=U.S. [[Food and Drug Administration]] (FDA)|access-date=12 June 2016|url-status=dead|archive-url=https://web.archive.org/web/20160611093318/https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm505303.htm|archive-date=11 June 2016}}</ref>

===Contraindications===
Treatment should be avoided in the presence of high [[fever]] or if the [[dysentery|stool is bloody]]. Treatment is not recommended for people who could have negative effects from rebound [[constipation]]. If suspicion exists of diarrhea associated with organisms that can penetrate the intestinal walls, such as [[Escherichia coli O157:H7|''E. coli ''O157:H7]] or ''[[Salmonella]]'', loperamide is [[contraindicated]] as a primary treatment.<ref name=drugs.com/> Loperamide treatment is not used in symptomatic ''[[Clostridium difficile colitis|C. difficile]]'' infections, as it increases the risk of toxin retention and precipitation of toxic megacolon.

Loperamide should be administered with caution to people with [[liver failure]] due to reduced [[first-pass metabolism]].<ref>{{ cite web | title = rxlist.com | year = 2005 | url = http://www.rxlist.com/imodium-drug/indications-dosage.htm | url-status = live | archive-url = https://web.archive.org/web/20121127021744/http://www.rxlist.com/imodium-drug/indications-dosage.htm | archive-date = 27 November 2012 | df = dmy-all }}</ref> Additionally, caution should be used when treating people with advanced [[HIV/AIDS]], as cases of both viral and bacterial toxic megacolon have been reported. If abdominal distension is noted, therapy with loperamide should be discontinued.<ref name=accessdata.fda.gov>{{cite web|url=http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_ApprovalHistory|title=Drugs@FDA: FDA Approved Drug Products|publisher=U.S. [[Food and Drug Administration]] (FDA)|access-date=14 May 2016|url-status=dead|archive-url=https://web.archive.org/web/20160506041852/http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_ApprovalHistory|archive-date=6 May 2016}}</ref>

===Children===
The use of loperamide in children under two years is not recommended. Rare reports of fatal [[paralytic ileus]] associated with [[abdominal distention]] have been made. Most of these reports occurred in the setting of acute [[dysentery]], overdose, and with very young children less than two years of age.<ref>{{ cite web | url = http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6651 | title = Imodium (Loperamide Hydrochloride) Capsule | work = DailyMed | publisher = NIH | url-status = live | archive-url = https://web.archive.org/web/20100413032222/http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=6651 | archive-date = 13 April 2010 | df = dmy-all }}</ref> A review of loperamide in children under 12 years old found that serious adverse events occurred only in children under three years old. The study reported that the use of loperamide should be contraindicated in children who are under 3, systemically ill, malnourished, moderately dehydrated, or have bloody diarrhea.<ref>{{cite journal | vauthors=Li ST, Grossman DC, Cummings P | title = Loperamide therapy for acute diarrhea in children: systematic and meta-analysis | journal = PLOS Medicine | volume = 4 | issue = 3 | date = 2007 | pages = e98 | pmid=17388664 | doi=10.1371/journal.pmed.0040098 | pmc=1831735 | doi-access = free }}</ref>

In 1990, all formulations for children of the antidiarrheal loperamide were banned in Pakistan.<ref>{{ cite web|url=http://www.essentialdrugs.org/edrug/archive/199708/msg00056.php |title=E-DRUG: Chlormezanone |publisher=Essentialdrugs.org |url-status=dead |archive-url=https://web.archive.org/web/20110726035911/http://www.essentialdrugs.org/edrug/archive/199708/msg00056.php |archive-date=26 July 2011 }}</ref>

The [[National Health Service]] in the United Kingdom recommends that loperamide should only be given to children under the age of twelve if prescribed by a doctor. Formulations for children are only available on prescription in the UK.<ref>{{cite web |date=20 December 2018 |title=Loperamide: a medicine used to treat diarrhoea |url=https://www.nhs.uk/medicines/loperamide/ |access-date=7 October 2023 |website=[[National Health Service]] }}</ref>

===Pregnancy and breast feeding===
Loperamide is not recommended in the United Kingdom for use during [[pregnancy]] or by [[breastfeeding|nursing mothers]].<ref>{{cite web|url=http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Diarrhoea&medicine=imodium|title=Medicines information links - NHS Choices|access-date=14 May 2016|url-status=dead|archive-url=https://web.archive.org/web/20140110171045/http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Diarrhoea&medicine=imodium|archive-date=10 January 2014}}</ref> Studies in rat models have shown no [[teratogen]]icity, but sufficient studies in humans have not been conducted.<ref>{{cite web|url=http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_ApprovalHistory#labelinfo|title=Drugs@FDA: FDA Approved Drug Products|publisher=U.S. [[Food and Drug Administration]] (FDA) |access-date=14 May 2016|url-status=dead|archive-url=https://web.archive.org/web/20160506041852/http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_ApprovalHistory#labelinfo|archive-date=6 May 2016}}</ref> One controlled, prospective study of 89 women exposed to loperamide during their first trimester of pregnancy showed no increased risk of malformations. This, however, was only one study with a small sample size.<ref>{{cite journal | vauthors = Einarson A, Mastroiacovo P, Arnon J, Ornoy A, Addis A, Malm H, Koren G | title = Prospective, controlled, multicentre study of loperamide in pregnancy | journal = Canadian Journal of Gastroenterology | volume = 14 | issue = 3 | pages = 185–7 | date = March 2000 | pmid = 10758415 | doi = 10.1155/2000/957649 | doi-access = free }}</ref> Loperamide can be present in breast milk and is not recommended for breastfeeding mothers.<ref name=accessdata.fda.gov/>