What anti diarrhea medicine is safe while breastfeeding

Pain

Avoid products with aspirin
Preferred medications are:

1. Acetaminophen, no more than 3000mg/24 hours
2. Ibuprofen, no more than 800mg every 6 hours
3. Naproxen (Alleve) is less ideal than Ibuprofen because Naproxen has a longer 1/2-life

Cold Medications

Avoid all products with decongestants such as pseudoephedrine and phenylephrine, because these can cause a significant decrease in milk supply.
Preferred medications are:

1. Cough medicines with guaifenesin (such as plain Robitussin)
2. Cough medications with dextromethorphan (such as Robitussin DM)
3. Nasal saline preparations
4. Neti Pot

Allergy Medications

Preferred medications are:

1. Antihistamines such as loratadine (Claritin), fenofexadine (Allegra), or cetirizine (Zyrtec) for sneezing and itchy eyes/nose, itching and hives.
2. Stronger antihistamines such as diphenhydramine (Benadryl) and chlorpheniramine (Chlortrimeton) occasionally can cause irritability in the baby and might reduce the milk supply in high doses.
3. Nasal cromolyn sodium (Nasalcrom)
4. Topical OTC creams/ointments such as hydrocortisone

Heartburn

Preferred medications are:

1. Ranitidine (Zantac), famotidine (Pepcid)
2. Omeprazole (Prilosec), lansoprazole (Prevacid)

Constipation

Preferred medications are:

1. Docusate Sodium, which are stool softeners.
2. Milk of Magnesia
3. Glycolax (Miralax), which is polyethylene glycol. This is not likely to enter the breastmilk
4. Dulcolax (Bisacodyl)- none enters the breastmilk
5. Psyllium- does not enter breastmilk

Diarrhea

Prescription lomotil (atropine/diphenoxylate) is not recommended during lactation.

Not much is known about anti-diarrheal medications during lactation, so it is best to use medications sparingly.
Preferred medication:

1. Loperamide (Immodium), over-the-counter

Motion Sickness

Preferred medications:

1. Meclizine (Bonine). Watch for infant sedation. In high doses, it could decrease maternal milk supply if used often.
2. Dimenhydrinate (Dramamine). Watch for infant sedation. In high doses, it could decrease maternal milk supply if used often.

Imodium generic Loperamide is an “Antidiarrheal” medicine commonly prescribed to provide symptomatic relief from acute nonspecific diarrhea. It is also used to treat chronic diarrhea in inflammatory bowel syndrome, short bowel syndrome, and for reducing drainage in patients with ileostomies. Loperamide works, like other opioid agonists, by slowing down the natural contractions of the intestine. As a result there are fewer bowel movements and a lesser amount of water enters the stool that controls the frequency of diarrhea. It is believed to start working within 24-48 hours of ingestion while Imodium AD half-life is estimated to be around 9-11 hours on an average. Generally, Imodium is well tolerated and mild side effects are self-resolving. However, its use during Pregnancy is still a debated topic as there’s a lack of adequate evidence to confirm its safety or harm during pregnancy.

Imodium And Pregnancy

A woman’s body undergoes innumerable changes during the 9 months of Pregnancy. These changes can be attributable to the dietary changes a woman makes after getting pregnant, hormonal changes or food sensitivities during Pregnancy. All of these changes and some common infections during Pregnancy make Diarrhea an unfortunate but frequent occurrence while a woman is pregnant. Diarrhea can result in loss of significant amounts of fluid and electrolytes leading to severe dehydration. Although diarrhea is rarely a life-threatening condition, it should be taken seriously especially when pregnant. Prompt and adequate rehydration is extremely important. As diarrhea can bring extreme discomfort during pregnancy, many women wonder whether one can take Imodium while pregnant. Loperamide side effects can sometimes be quite severe. It is, therefore, natural that there is a concern about the safety of Loperamide during pregnancy and breastfeeding.

Can You Take Imodium While Pregnant?

There is a lot of controversy around the use of medications during pregnancy. The use of Imodium while nursing or trying to get pregnant is also frequently disapproved. To understand why this attitude takes place, it is necessary to briefly discuss what loperamide is and what specific properties allow it to help with diarrhea. Loperamide is an active ingredient of Loperamide. It is an opioid-receptor agonist similar to morphine, and works by depressing the activity of the gut. Although in normal doses loperamide doesn’t reach the brain, its potential psychoactive properties force many people to doubt if one can take Imodium while pregnant.

According to the FDA, Imodium pregnancy category is C. It means that no adequate studies have been conducted to determine the safety of the medicine for pregnant women and their babies. It appears that Loperamide OTC is a reasonably safe medication due to the absence of reported adverse consequences of its use during pregnancy. However, generally, it is recommended to always consult with a doctor before taking any medication during pregnancy.

In certain cases, the benefits of loperamide during pregnancy can greatly outweigh the potential risks. For instance, diarrhea can pose a serious threat to a pregnant woman. Dehydration can occur quickly and result in severe consequences and the development of other digestive problems. If diarrhea lasts for more than three days, a doctor’s prescription of Loperamide for pregnant women may be helpful.

When a Woman Is Already Taking Imodium While Pregnant

Doctors usually advise women to avoid using Loperamide in the first trimester of pregnancy. This is the period when a baby is undergoing rapid and major development. Hence, it is necessary to take additional precautions whenever possible. However, if a woman has already taken this drug being pregnant, there is no reason to panic. This drug does not have registered negative impacts on the health of an unborn baby. The next step would be to consult with a doctor prior to taking the next dose. This would help adjust the treatment plan and ensure that both the mother and the child remain safe and healthy.

Furthermore, Imodium is found to interact with other drugs which have the similar way of breaking down inside the body. Mixing loperamide and alcohol also poses additional adverse effects on the nervous system, including dizziness, drowsiness, and difficulties concentrating which might also result in overdosing. Interactions of this drug and other medicines such as Zantac are associated with Cardiac abnormalities and it seems to halt elimination of Antibiotics from the body, hence interfering with the course of treatment. So, Loperamide shouldn’t be prescribed for diarrhea which is being treated with antibiotics.

Side Effects Of Taking Imodium While Pregnant

On its own, loperamide is deemed safe during pregnancy. However, Imodium drug interactions with other medicines can produce harmful effects. Pregnant women might be more susceptible to experiencing various side effects of Loperamide and the negative symptoms of its combination with other drugs.

Common Side Effects of Loperamide in Pregnant Women Are:

1. Constipation: Constipation is the most common adverse effect of this drug. It can occur to pregnant women also which can be very unpleasant.
2. Abdominal pain and discomfort: Gas and bloating are common symptoms after ingesting it can lead to significant discomfort in pregnant ladies.
3. Nausea and Vomiting: Pregnant women in the first trimester already struggle with morning sickness. So, nausea and vomiting can be debilitating for pregnant women.
4. Tiredness and Dizziness: As drowsiness, fatigue and dizziness are among the symptoms commonly associated with Loperamide, it can also affect a pregnant woman.
5. A woman can also suffer from dyspepsia, flatulence and dry mouth after taking this drug. However, most of the time these symptoms don’t last long and are self-limiting. If any of these symptoms worsen then seeking for medical assistance is strongly advised.

Ingestion of Loperamide may cause some unwanted effects, however most of the time these symptoms don’t last long and are self-limited. If any of these symptoms worsen then seeking for medical assistance is strongly advised, as a doctor can recommend alternatives to Loperamide. Additionally, it is best to talk to a doctor before taking this drug if a person is on other medication for treatment of other health related problems. It’s best to avoid drinking alcohol during pregnancy, especially when taking Loperamide.

The FDA warns that small amounts of loperamide can pass into the milk. It is also noted that Imodium is not recommended while breastfeeding. However, the National Center for Biotechnology Information reports that the use of loperamide during breastfeeding is not likely to affect the baby. The National Health Service in England also claims that the use of this drug should be safe for nursing mothers who take it for up to two days. Overall, this medicine can be taken during breastfeeding, but the mother should consult with a medical professional before taking it. A doctor can evaluate the risks and determine whether it can be beneficial for the woman in her situation.

Is Imodium Safe For Kids?

Imodium use is strictly prohibited for toddlers younger than 2 years of age as there have been reports of paralytic ileus (inability to pass bowel contents due to reduced intestinal contraction) associated with abdominal distention. Kids Imodium is used to treat diarrhea which has not been caused by a bacterial infection. However, for kids under 12 years old with diarrhea, loperamide should not be administered without a doctor’s consultation.

• Age 12 years and above: Same dose as adults
• Age 12 to 17 years with IBS or Chronic Diarrhea: Strictly following the instructions by a treating physician, as prescribed by him/her.
• Age 11 years or younger: Only after consultation with a doctor.

Its dosage for children depends both on the weight and the age of the child suffering from diarrhea.

Imodium Dosage For Kids And the Formulations Available

The dosage for the children depends on their age and weight. So, be sure to check them before administering the drug. Remember that children below the age of 2 shouldn’t be given the medication. Kids between the age of 2-5 years can only be given the liquid formulation of the medicine.

The liquid formulations have the same color for the bottle but different caps, depending on the manufacturing company. So, don’t be confused with purchasing it. Strictly follow the prescription on the packaging or the leaflet inside the packet to avoid further complications.

Loperamide Formulations For Children

Just like adults, the medicine’s formulations for children come in different varieties. The formulations for children include Imodium liquid, also referred to as oral suspension, and chewable tablets. These formulations can be used depending on the age of the patients.

Note that Loperamide is not recommended for children below the age of 2 years.

There Are Chewable Tablets, Oral Suspensions, Caplets, and Softgels:

• Loperamide Chewable Tablets is usually marketed under the brand name Imodium Advanced. It is effective in the treatment of diarrhea in children. It is highly recommended to be chewed before swallowing to enable it to work faster. When combined with Simethicone it treats other symptoms of diarrhea such as cramps, bloating, and pressure. Simethicone is responsible for fighting the symptoms of diarrhea while loperamide concentrates on the treatment of diarrhea. It is recommended for use in children above the age of 5 years.
• Imodium Oral Suspension also known as Imodium liquid is efficient in treating diarrhea in children between 2 and 5 years. This drug also treats traveler’s diarrhea. It is administered with a dosing syringe or a dosing cup, depending on the brand and packaging. Using a spoon is not recommended. Be sure to shake the bottle to ensure the medication is evenly mixed.
• Imodium Caplets can be taken by children who are 6 years and older and weigh between 20-30kg. Though this drug can be taken by children within the age bracket of 2-5 years, it must be recommended by a physician. The caplets treat diarrhea in kids and help to get rid of traveler’s diarrhea as well. The tablets are capsule-shaped and are to be administered orally with lots of water.
• Imodium Softgels are for 12-year-olds and above who are heavier than 30kg. These drugs are soft and make swallowing easier. The softgels are filled with liquid and can be accompanied by water. It also treats symptoms of diarrhea such as bloating and cramps. It helps in the recovery from diarrhea.
• Imodium Multi-symptom Relief Caplets come with Simethicone which is useful in treating symptoms associated with diarrhea. Its core ingredient, Loperamide, is responsible for combating diarrhea in children. These drugs can only be used in children between 2 – 5years by a doctor’s prescription, otherwise, it is meant for children who are 6 years and above.

When to Give Imodium to Children

Normally, sudden diarrhea will get better between five and seven days irrespective of age. However, diarrhea leads to dehydration quicker in kids than adults. It is, therefore, recommended to give younger patients a children’s Imodium dosage when kids have diarrhea.

However, it is not advisable to give loperamide to children below the age of 2 years old without the permission of a doctor. This is because diarrhea can be fatal in infants below this age. Therefore, the doctor will first determine the cause of a child’s diarrhea and then determine the most suitable Loperamide pediatric dose. It is not recommended to take a kid’s Imodium for more than a day without a prescription. When diarrhea is persistent for more than 24 hours, contact a doctor for the right instruction. In the case a child has a high fever, stool with blood, or stool with pus; parents need to have a medical professional’s directions on how to give the kid’s Imodium.

Imodium Side Effects in Children

Children are presumed to react differently to this drug than adults. Therefore, it is expected that the loperamide side effects for kids will be a little different from those of adults. Listed below are the side effects that parents should be keen to note when giving Imodium AD for children:

• itchiness or a rash
• nausea
• cramps at the abdomen or stomach pain
• constant and repeated crying for toddlers
• stomach enlargement
• a lot of gas release
• dry mouth
• constipation
• bloating or wind

When the side effects outweigh the benefits, it is better to consider loperamide alternatives. Furthermore, the most common result of diarrhea is losing a lot of water in the body. This is called dehydration. It is the reason diarrhea in children can be fatal if children’s Imodium is not administered. That’s why it is recommended to give children a lot of water or any other form of liquid. Imodium AD for children works by reducing water and, therefore, electrolyte loss in the child’s body.

Parents Should We Aware of the Following Dehydration Signs and Symptoms:

• irritation
• abnormal fever
• sunken eyes and cheeks
• lack of tears when crying
• skull with soft spots
• baby diapers that are not wet for three hours or more
• dry tongue and mouth
• lack of energy

Severe dehydration is a major cause of infant mortality worldwide. It results in about 760,000 deaths each year of children with diarrheal diseases where treatments such as Imodium AD for toddlers are not available.

In most cases, water won’t be enough to alleviate the dehydration. Hence, giving children other fluid supplements such as NaturaLyte in combination with Loperamide pediatric dose to boost the electrolyte levels in the body.

Preventing Children’s Imodium Side Effects

Although the majority of adverse effects associated with its use are temporary and will vanish with time, a person can reduce the occurrence of these scenarios by educating about this drug.

Additionally One Can Take Certain Precautions Before and During the Treatment With Loperamide:

• Replace the fluids and electrolytes lost by giving them plenty of water and fresh juices.
• Make sure to follow the Imodium directions of use as indicated on the label, unless there are no doctor’s instructions.
• Its use should be monitored cautiously among children as the response shows greater variability in this age group, mostly influenced by dehydration.
• Children’s Imodium for diarrhea is prescribed for symptomatic relief. After the underlying etiology is determined, definitive treatment should be started.

Loperamide ingestion during pregnancy, breastfeeding and childhood is a controversial topic. Hence, it’s wise to consult with a doctor if one wants quick relief from acute diarrheal problems during any of these conditions. As the doctor will be able to weigh the benefits and harms of this drug specifically for a patient’s condition.

Be Aware Of Using Imodium During Pregnancy And Know How To Give Medication to Kids

When it comes to loperamide during pregnancy, there is a lack of clear evidence to claim it to be completely safe. At the same time, the cases of Imodium causing harm are scarce and not well documented. Loperamide can be used during pregnancy by a doctor’s recommendation. In addition, there is a discussion about whether women can take Imodium while breastfeeding. Loperamide can appear in the milk, and although the amounts are minuscule, nursing mothers are advised against taking this medication. Several alternative medicines that do not affect a mother and a child while displaying the same properties are available. It is important to remember that no one should switch to a different medication or alter the course of treatment without receiving a professional medical consultation in the drug facilities. If a woman notices any signs of medication misuse, it is vital to consult in the drug facilities and get proper treatment. Do not give the drug to children who are under 2 years old without consulting a doctor. Parents should be cautious whenever they administer children’s Imodium to treat diarrhea. People should consider it in terms of how and when to give a pediatric dose of the drug and the side effects that may arise afterward.

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Page Sources

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Published on: May 6th, 2019

Updated on: August 2nd, 2021

Olivier George, Ph.D.

Olivier George is a medical writer and head manager of the rehab center in California. He spends a lot of time in collecting and analyzing the traditional approaches for substance abuse treatment and assessing their efficiency.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.