Loperamide During Pregnancy – Safety, Dosage and Side Effects

Loperamide Ingredients, Their Action, and Dosage

Structurally, loperamide is an opioid receptor agonist. It acts as an anti-diarrheal agent by relaxing the movement of muscles in the gut, thereby inhibiting the passing of stool often. Loperamide is usually available in 2mg dosages in different dosage forms, such as tablet, chew able tablets, as well as in liquid (1 mg/5 ml) and suspension form. (1mg/ 7.5ml). A few available brand names are Eldoper, Lopamide, Imodium, etc.  Taking loperamide for more than 48 hours is not recommended. (1) Even though it is an OTC drug, taking it at the doctor’s suggestion is advised in pregnancy. 

Is It Safe To Take Loperamide During Pregnancy?

There have been many studies done to understand the safety of loperamide during pregnancy. (2). The US FDA pregnancy category mentioned Loperamide as a category C medicine, which states that animal studies have shown adverse risks to the fetus but no adequate information on pregnant women. However, the drug can show potential benefits and may be used when the benefits outweigh the risks in pregnancy. 

Few prospective studies have suggested use of loperamide in the first trimester is safe and not associated with an increased risk of major malfunctions to the fetus, but overuse of loperamide throughout the pregnancy has resulted in low birthweight in a few babies. (2)

What Are the Risks Associated With Taking Loperamide During Pregnancy?

In contrast, few studies have mentioned that the use of loperamide during the first trimester may lead to a moderate risk of malformation in infants. Studies have observed an increased risk of hypospadias, -a condition of birth defect in boys where the opening of the urethra is not developed at the tip of the penis but can be anywhere from the penis to the scrotum (3)  

Women taking loperamide during the first trimester may have the risk of developing placenta previa, a condition in which the placenta attaches low in the uterus, mostly near the opening of the cervix, which may cause severe blood loss during delivery. Large fetuses for gestational age and chances of C-section have also increased. (3) 

Loperamide misuse or abuse in pregnancy may lead to potential cardiovascular effects and prompt delivery of the fetus, as warned by a few studies (4). Some studies mention in higher doses than 100 mg, there are certain risks of cardiac toxicity, ventricular fibrillation, and sudden cardiac death.

Are There Any Side Effects Of Loperamide During Pregnancy?

Loperamide can have a few common and adverse side effects while taking  

Common side effects of Loperamide include (1)

• Dryness of mouth
• Flatulence (passing gas)
• Abdominal cramps
• Nausea
• Constipation
• Urinary retention
• Dizziness and Drowsiness

Serious Adverse Effects 

A few potential cardiac effects, including cardiac arrest, inflammation of the colon and intestines leading to necrosis, Stevens-Johnson syndrome, skin damage leading to necrosis, etc., are adverse effects of Loperamide observed in a few patients.

What Are the Alternatives to Loperamide During Pregnancy?

Acute diarrhoea is always short and mild. Considering fluid replenishment and dietary recommendations as the best and most effective alternatives possible to loperamide and other such medicines. The main thing to address is dehydration, which can be severe in pregnant populations. Drinking oral rehydration salt (ORS) solutions is essential and will be effective for both mother and fetus. 

1. Pregnant women can take as much ORS as up to 3 liters in divided amounts whenever required. ORS has no risk to the fetus at all. ORS solutions containing glucose or starch are very effective in these times. (5)
2. Dietary recommendations include small and frequent meals. Eating salty and starchy foods like soups, good carbohydrates, and fruit juices that are low in fat helps replenish the salts that are lost and the energy needed for the body. Yogurt or curd will help as a probiotic to maintain the balance of good gut bacteria. (5)
3. IV hydration with electrolytes may be helpful. Chronic diarrhoea needs to be ruled out for infection or other causes and may need antibiotics or other medication.

Diarrhea can be a concern for pregnant women. Most of the mild cases can be resolved on their own in a short span. Using OTC medications like Loperamide always comes with great caution in pregnancy. It’s always better that pregnant women refrain from using OTC medications without consulting doctors. Taking a prescription and getting suggestions from the doctor is highly recommended while taking Loperamide, as it may have potential risks during the first trimester, as few studies say. Taking advice from the doctors regarding dose and dosage is considered safe to avoid the risk and to get the benefit of the drug.

FAQ’s

1. Is Loose Stool Normal in Pregnancy?

It is common to experience loose stool in the initial weeks of pregnancy due to hormonal changes and digestive disturbances. Severe and ongoing loose motions require medical attention and prompt treatment.

References

1. Loperamide
   [https://europepmc.org/article/NBK/nbk557885#article-24418.r4]
2. Prospective, controlled, multicentre study of loperamide in pregnancy
   [https://pubmed.ncbi.nlm.nih.gov/10758415/]
3. Maternal use of loperamide in early pregnancy and delivery outcome
   [https://pubmed.ncbi.nlm.nih.gov/18394096/]
4. Loperamide toxicity mimicking peripartum cardiomyopathy
   [https://www.sciencedirect.com/science/article/abs/pii/S0735675719307090?via%3Dihub]
5. Fecal Incontinence and Diarrhea During Pregnancy
   [https://journals.lww.com/ajg/Fulltext/2022/10001/Fecal_Incontinence_and_Diarrhea_During_Pregnancy.5.aspx10]