Last update Feb. 16, 2022

Loperamide Hydrochloride

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

Synthetic pethidine derivative and peripheral opioid agonist that inhibits intestinal motility and may reduce gastrointestinal secretions. Used in diarrhea and in the management of colostomies and ileostomies. Oral administration 3 to 5 times a day.

Excreted into breast milk in non-significant levels. (Nikodem 1992)

Its very low oral bioavailability (intestinal absorption practically nil) minimizes the passage into plasma of the infant from ingested breast milk, except in the premature and in the immediate neonatal period in which there may be greater intestinal permeability.

No side effects have been reported in infants of mothers taking loperamide. (Schaefer 2015)

Indiscriminate use for treatment of gastroenteritis is not justified. Most acute diarrheic disorders are self-limijted conditions. WHO’s Oral Rehydration Solutions and appropriate nutritional support are recommended.

Several medical societies, experts and expert consensus, consider the use of this medication to be safe or very probably safe during breastfeeding. (Hale acces.02/2022, LactMed acces.02/2022, Briggs 2015, Schaefer 2015, Chen 2010, Mahadevan 2006, Nice 2000, Hagemann 1998)

American Academy of Pediatrics: medication usually compatible with breastfeeding. (AAP 2001)

Alternatives

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Loperamide Hydrochloride is also known as


Loperamide Hydrochloride in other languages or writings:

Tradenames

Main tradenames from several countries containing Loperamide Hydrochloride in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 0.3 %
Molecular weight 477 daltons
Protein Binding 97 %
pKa 13.96 -
Tmax 2.5 - 5 hours
11 (9 - 14) hours
M/P ratio 0.4 -
Theoretical Dose 0.00004 mg/Kg/d
Relative Dose 0.02 %
Ped.Relat.Dose 0.01 %

References

  1. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on March 17, 2022 Full text (link to original source)
  2. LactMed. Drugs and Lactation Database (LactMed). Internet. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/ 2006 - Consulted on March 15, 2022 Full text (link to original source)
  3. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  4. Schaefer C, Peters P, Miller RK. Drugs During Pregnancy and Lactation. Treatment options and risk assessment. Elsevier, Third Edition. 2015
  5. Regnard C, Twycross R, Mihalyo M, Wilcock A. Loperamide. J Pain Symptom Manage. 2011 Abstract Full text (link to original source) Full text (in our servers)
  6. Chen LH, Zeind C, Mackell S, LaPointe T, Mutsch M, Wilson ME. Breastfeeding travelers: precautions and recommendations. J Travel Med. 2010 Jan-Feb;17(1):32-47. Abstract Full text (link to original source) Full text (in our servers)
  7. Mahadevan U, Kane S. American gastroenterological association institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006 Jul;131(1):283-311. Review. Abstract Full text (link to original source) Full text (in our servers)
  8. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Abstract Full text (link to original source) Full text (in our servers)
  9. Nice FJ, Snyder JL, Kotansky BC. Breastfeeding and over-the-counter medications. J Hum Lact. 2000 Nov;16(4):319-31. Review. Erratum in: J Hum Lact 2001 Feb;17(1):90. Abstract
  10. Hagemann TM. Gastrointestinal medications and breastfeeding. J Hum Lact. 1998 Sep;14(3):259-62. Review. Abstract
  11. Nikodem VC, Hofmeyr GJ. Secretion of the antidiarrhoeal agent loperamide oxide in breast milk. Eur J Clin Pharmacol. 1992 Abstract

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