What is Loremid?
Loremid slows the rhythm of digestion so that the small intestines have more time to absorb fluid and nutrients from the foods you eat.
Loremid is used to treat diarrhea. Loremid is also used to reduce the amount of stool in people who have an ileostomy (re-routing of the bowel through a surgical opening in the stomach).
Loremid may also be used for purposes not listed in this medication guide.
Loremid® (Loremid) is indicated for the control and symptomatic relief of acute nonspecific diarrhea and of chronic diarrhea associated with inflammatory bowel disease. Loremid® (Loremid hcl) is also indicated for reducing the volume of discharge from ileostomies.
How should I use Loremid?
Use Loremid solution as directed by your doctor. Check the label on the medicine for exact dosing instructions.
- Take Loremid solution by mouth with or without food.
- Use the measuring cup that comes with Loremid solution. Ask your pharmacist for help if you are unsure of how to measure your dose.
- Drinking extra fluids is recommended while you have diarrhea. Check with your doctor if you have questions.
- If you miss a dose of Loremid solution, take it as soon as you remember. Continue to take it as directed by your doctor or on the package label.
Ask your health care provider any questions you may have about how to use Loremid solution.
Uses of Loremid in details
This medication is used to treat sudden diarrhea (including traveler's diarrhea). It works by slowing down the movement of the gut. This decreases the number of bowel movements and makes the stool less watery. Loremid is also used to reduce the amount of discharge in patients who have had an ileostomy. It is also used to treat ongoing diarrhea in people with inflammatory bowel disease.
Loremid treats only the symptoms, not the cause of the diarrhea (e.g., infection). Treatment of other symptoms and the cause of the diarrhea should be determined by your doctor.
Do not use in children younger than 6 years unless directed by your doctor. This medication should not be used in infants younger than 24 months.
How to use Loremid (Loremid)
If you are using the over-the-counter product to self-treat, read all the directions on the product package before taking this medication. If your doctor has prescribed this medication, follow your doctor's directions and the directions on your prescription label.
Take this medication by mouth, usually after each loose stool or as directed by your doctor. Shake the bottle well before each use. Measure each dose carefully using the attached measuring cup. Do not use a household spoon since you may not get the correct dose.
The dosage is based on your condition and response to treatment. In children, dosage is also based on age and weight. Adults should not use more than 8 milligrams in 24 hours if self-treating, or 16 milligrams in 24 hours if under a doctor's direction.
Improper use of this medication (overuse or abuse) - or use with certain other medications - may cause serious harm, such as fast/irregular heartbeat or death. Do not increase your dose, take it more often, or use it for longer than directed. Be sure to tell your doctor or pharmacist about all the products you use (including prescription, nonprescription, and herbal products).
Diarrhea can cause a serious loss of body water (dehydration). Drink plenty of fluids and minerals (electrolytes) to replace what is lost. Tell your doctor right away if you develop signs of dehydration (e.g., extreme thirst, decreased urination, muscle cramps, weakness, fainting). You may also need to change to a bland diet during this time to reduce irritation to your stomach/intestines. Consult your doctor or pharmacist for more information.
Tell your doctor if your diarrhea does not improve after 2 days, if your condition worsens, or if you develop new symptoms. If you develop blood in the stool, fever, or an uncomfortable fullness/swelling of the stomach/abdomen, or if you think you may have a serious medical problem, seek immediate medical attention.
If you are taking this medication under your doctor's direction for ongoing diarrhea, tell your doctor if your diarrhea continues after 10 days of treatment.
One of the long-acting synthetic antidiarrheals; it is not significantly absorbed from the gut, and has no effect on the adrenergic system or central nervous system, but may antagonize histamine and interfere with acetylcholine release locally. [PubChem]
(1 capsule = 2 mg)
Patients should receive appropriate fluid and electrolyte replacement as needed.
Adults: The recommended initial dose is 4mg (two capsules) followed by 2 mg (one capsule) after each unformed stool. Daily dose should not exceed 16mg (eight capsules). Clinical improvement is usually observed within 48 hours.
Children: In children 2 to 5 years of age (20 kg or less), the non-prescription liquid formulation (Loremid® (Loremid hcl) A-D 1 mg/5 mL) should be used; for ages 6 to 12, either Loremid® (Loremid hcl) Capsules or Loremid® (Loremid hcl) A-D Liquid may be used. For children 2 to 12 years of age, the following schedule for capsules or liquid will usually fulfill initial dosage requirements:
Recommended First Day Dosage Schedule
Two to five years: 1 mg t.i.d. (3mg daily dose) (13 to 20 kg) Six to eight years: 2 mg b.i.d. (4mg daily dose) (20 to 30 kg) Eight to twelve years: 2mg t.i.d. (6mg daily dose) (greater than 30 kg)
Recommended Subsequent Daily Dosage
Following the first treatment day, it is recommended that subsequent Loremid® (Loremid hcl) doses (1 mg/10 kg body weight) be administered only after a loose stool. Total daily dosage should not exceed recommended dosages for the first day.
Children: Although Loremid® (Loremid hcl) has been studied in a limited number of children with chronic diarrhea; the therapeutic dose for the treatment of chronic diarrhea in a pediatric population has not been established.
Adults: The recommended initial dose is 4 mg (two capsules) followed by 2 mg (one capsule) after each unformed stool until diarrhea is controlled, after which the dosage of Loremid® (Loremid hcl) should be reduced to meet individual requirements. When the optimal daily dosage has been established, this amount may then be administered as a single dose or in divided doses.
The average daily maintenance dosage in clinical trials was 4 to 8 mg (two to four capsules). A dosage of 16 mg (eight capsules) was rarely exceeded. If clinical improvement is not observed after treatment with 16 mg per day for at least 10 days, symptoms are unlikely to be controlled by further administration. Loremid® (Loremid hcl) administration may be continued if diarrhea cannot be adequately controlled with diet or specific treatment.
Children under 2 Years
The use of Loremid (Loremid hcl) in children under 2 years is not recommended. There have been rare reports of paralytic ileus associated with abdominal distention. Most of these reports occurred in the setting of acute dysentery, overdose, and with very young children less than two years of age.
No formal pharmacokinetic studies were conducted in elderly subjects. However, there were no major differences reported in the drug disposition in elderly patients with diarrhea relative to young patients. No dosage adjustment is required for the elderly.
No pharmacokinetic data are available in patients with renal impairment. Since the metabolites and the unchanged drug are mainly excreted in the feces, no dosage adjustment is required for patients with renal impairment.
Although no pharmacokinetic data are available in patients with hepatic impairment, Loremid (Loremid hcl) should be used with caution in such patients because of reduced first pass metabolism..
Capsules - each capsule contains 2 mg of Loremid. The capsules have a light green body and a dark green cap with "JANSSEN" imprinted on one segment and "Loremid" on the other segment. Loremid® (Loremid hcl) capsules are supplied in bottles of 100.
NDC 50458-400-10.........(100 CAPSULES)
Store at 15°-25°C (59°-77°F).
Janssen Pharmaceutica Inc. Revised September 1996, July 1998. FDA Rev date: 10/21/2005
Nonclinical data have shown that Loremid is a P-glycoprotein substrate. Concomitant administration of Loremid (16 mg single dose) with a 600 mg single dose of either quinidine, or ritonavir, both of which are P-glycoprotein inhibitors, resulted in a 2- to 3- fold increase in Loremid plasma levels. Due to the potential for enhanced central effects when Loremid is coadministered with quinidine and with ritonavir, caution should be exercised when Loremid is administered at the recommended dosages (2 mg, up to 16 mg maximum daily dose) with P-glycoprotein inhibitors.
When a single 16-mg dose of Loremid is coadministered with a 600 mg single dose of saquinavir, Loremid decreased saquinavir exposure by 54%, which may be of clinical relevance due to reduction of therapeutic efficacy of saquinavir. The effect of saquinavir on Loremid is of less clinical significance. Therefore, when Loremid is given with saquinavir, the therapeutic efficacy of saquinavir should be closely monitored.
Loremid side effects
Clinical Trial Data
The adverse effects reported during clinical investigations of Loremid® (Loremid) are difficult to distinguish from symptoms associated with the diarrheal syndrome. Adverse experiences recorded during clinical studies with Loremid® (Loremid hcl) were generally of a minor and self-limiting nature. They were more commonly observed during the treatment of chronic diarrhea.
The adverse events reported are summarized irrespective of the causality assessment of the investigators.
1) Adverse events from 4 placebo-controlled studies in patients with acute diarrhea The adverse events with an incidence of 1.0% or greater, which were reported at least as often in patients on Loremid as on placebo, are presented in the table below.
| Loremid |
|No. of treated patients||231||236|
| Gastrointestinal AE% |
The adverse events with an incidence of 1.0% or greater, which were more frequently reported in patients on placebo than on Loremid, were: dry mouth, flatulence, abdominal cramp and colic.
2) Adverse events from 20 placebo-controlled studies in patients with chronic diarrhea
The adverse events with an incidence of 1.0% or greater, which were reported at least as often in patients on Loremid as on placebo, are presented below in the table below.
| Loremid |
|No. of treated patients||285||277|
| Gastrointestinal AE% |
| Central and peripheral |
nervous system AE%
The adverse events with an incidence of 1.0% or greater, which were more frequently reported in patients on placebo than on Loremid were: nausea, vomiting, headache, meteorism, abdominal pain, abdominal cramp and colic.
3) Adverse events from seventy-six controlled and uncontrolled studies in patients with acute or chronic diarrhea
The adverse events with an incidence of 1.0% or greater in patients from all studies are given in the table below.
|Acute Diarrhea||Chronic Diarrhea||All Studies|
|No. of treated patients||1913||1371||3740|
|a. All patients in all studies, including those in which it was not specified if the adverse events occurred in patients with acute or chronic diarrhea.|
Post -marketing experience
The following adverse events have been reported:
Skin and subcutaneous tissue disorders
Rash, pruritus, urticaria, angioedema, and extremely rare cases of bullous eruption including erythema multiforme, Stevens-Johnson syndrome and Toxic Epidermal Necrolysis have been reported with use of Loremid (Loremid hcl).
Immune system disorders
Isolated occurrences of allergic reactions and in some cases severe hypersensitivity reactions including anaphylactic shock and anaphylactoid reactions have been reported with the use of Loremid (Loremid hcl).
Dry mouth, abdominal pain, distention or discomfort, nausea, vomiting, flatulence, dyspepsia, constipation, paralytic ileus, megacolon, including toxic megacolon.
Renal and urinary disorders
Nervous system disorders
General disorders and administrative site conditions
A number of the adverse events reported during the clinical investigations and post- marketing experience with Loremid are frequent symptoms of the underlying diarrheal syndrome (abdominal pain/discomfort, nausea, vomiting, dry mouth, tiredness, drowsiness, dizziness, constipation, and flatulence). These symptoms are often difficult to distinguish from undesirable drug effects.
Drug Abuse And Dependence
A specific clinical study designed to assess the abuse potential of Loremid at high doses resulted in a finding of extremely low abuse potential.
Studies in morphine-dependent monkeys demonstrated that Loremid at doses above those recommended for humans prevented signs of morphine withdrawal. However, in humans, the naloxone challenge pupil test, which when positive indicates opiate-like effects, performed after a single high dose, or after more than two years of therapeutic use of Loremid® (Loremid), was negative.
Orally administered Loremid® (Loremid hcl) (Loremid formulated with magnesium stearate) is both highly insoluble and penetrates the CNS poorly.
Loremid (Loremid hcl) is contraindicated in patients with a known hypersensitivity to Loremid or to any of the excipients.
Loremid (Loremid hcl) is contraindicated in patients with abdominal pain in the absence of diarrhea.
Loremid (Loremid hcl) is not recommended in infants below 24 months of age.
Loremid (Loremid hcl) should not be used as the primary therapy:
- in patients with acute dysentery, which is characterized by blood in stools and high fever,
- in patients with acute ulcerative colitis,
- in patients with bacterial enterocolitis caused by invasive organisms including Salmonella, Shigella, and Campylobacter,
- in patients with pseudomembranous colitis associated with the use of broad- spectrum antibiotics.
Active ingredient matches for Loremid:
Loperamide in Paraguay.
Loperamide hydrochloride in Indonesia.
List of Loremid substitutes (brand and generic names)
|Sort by popularity|
|Unit description / dosage (Manufacturer)||Price, USD|
|Lordiar (Bosnia & Herzegowina)|
|Lormide (Philippines, Vietnam)|
|Lormide 2 mg x 25 Blister x 4 Tablet (Westmont)|
|Lormide 2 mg x 100's (Westmont)||$ 15.21|
|Lorpa 2 mg x 500's (Beacons)|
|Lorpa 1 mg/5 mL x 1 L x 1's (Beacons)|
|LUPIDIUM TABLET 1 strip / 10 tablets each (Lupin Ltd)||$ 0.06|
|Maalox Anti-Diarrheal (United States)|
|Mandros Diarstop (Germany)|
|Mantil 2 mg x 50 x 10's|
|Mantil 2 mg x 100 x 10's|
|Mar-Loper (Hong Kong)|
|Miderlar 2 mg x 25 x 6's|
|Miderlar 2 mg x 1000's|
|NEDAC SORBO Loperamide HCl (Netherlands)|
|Nelop 2 mg Capsule (Nestor Pharmaceuticals Ltd)||$ 0.02|
|Neo - enteroseptol (Romania)|
|Neo-Diaral (United States)|
|Neo-Enteroseptol (Georgia, Greece, Romania)|
|Nitilop 2 mg Tablet (Woodrock Healthcare Pvt. Ltd.)||$ 0.02|
|Norimode (South Africa, United Kingdom)|
|Normakut 2 mg (Austria)|
|Normaloe (United Kingdom)|
|Normotil 2 mg x 6 x 10's (Novell)||$ 5.58|
|Normudal 2 mg x 50's (Combiphar)||$ 3.39|
- PubChem. "loperamide". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
- DrugBank. "loperamide". http://www.drugbank.ca/drugs/DB00836 (accessed September 17, 2018).
- MeSH. "Antidiarrheals". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology