Loperamide Contraindications and Precautions

Gastrointestinal Considerations

The American Gastroenterological Association recommends that loperamide should be used with caution in patients with C. difficile infection as high-dose loperamide may predispose to toxic dilatation, especially in neutropenic patients 1
Loperamide may be given safely in patients with diarrhea before results of microbiology tests to exclude infection are available, but monitor closely, as suggested by the European Society of Clinical Microbiology and Infectious Diseases 1
Avoid in cases of complete intestinal obstruction and severe abdominal pain, which require emergency surgical assessment, according to the American College of Surgeons 1

The Infectious Diseases Society of America recommends that loperamide should be used with caution in patients with fever and bloody diarrhea (dysentery) 2, 3
The Centers for Disease Control and Prevention suggest that patients with inflammatory diarrhea where slowing intestinal transit may worsen condition should use loperamide with caution 3, 4
The American Academy of Pediatrics recommends that patients with suspected STEC (Shiga toxin-producing E. coli) infections should avoid using loperamide, as antimotility agents may increase risk of hemolytic uremic syndrome 4