II. Indications
III. Contraindications
- Clostridioides difficile
- Dysentery (toxigenic Diarrhea)
- Child under age 2 years
IV. Mechanism
- Peripherally acting Opioid
V. Dosing: Acute Diarrhea
- Adult
- Initial: 4 mg orally for single first dose
- Titrate: 2 mg PO after each loose stool
- Maximum: 16 mg/day
- Child Age 9 to 12 year old (weight >30 kg)
- Give 2 mg orally three times daily
- Then 0.1 mg/kg orally after each loose stool
- Maximum: 6 mg/day in divided doses
- Child Age 6 to 8 years old (weight 21 to 30 kg)
- Give 2 mg orally twice daily
- Then 0.1 mg/kg orally after each loose stool
- Maximum: 4 mg/day in divided doses
- Child Age 2 to 5 years old (weight 13 to 20 kg)
- Give 1 mg orally three times daily on day 1
- Then 0.1 mg/kg orally after each loose stool
- Maximum: 3 mg/day in divided doses
VI. Dosing: Chronic Diarrhea or High Ileostomy Output
- Adults
- Start 4 mg
- Then 2 mg after each loose stool until Diarrhea is controlled
- Then taper to maintenance 4 to 8 mg/day in divided doses (or as single dose)
- Maximum: 16 mg/day
- Child (over age 2 years)
- Start 0.08 to 0.24 mg/kg/day orally divided 2 to 3 times daily
- Maximum: 2 mg/dose and 16 mg/day
VII. Safety
- Pregnancy Category C
- Safe in Lactation
VIII. Adverse Effects
IX. Resources
X. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 96
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