The diarrhea-predominant and mixed types of irritable bowel syndrome (IBS) can cause repeating, disabling bouts of diarrhea that’s difficult to treat.
IBS is a long-term functional disorder of the gut and while doctors aren’t sure what causes it, we know it doesn’t cause “physical” damage or inflammation of the gut.
Over-the-counter antidiarrheals like Imodium (and Pepto Bismol) are easily available and you may be inclined to use one every day during an IBS flare. Your doctor would tell you that’s a bad idea.
Let’s take a look at what Imodium is, how it’s supposed to be used, whether you should use it to treat IBS diarrhea, and if it’s effective for IBS.
How does Imodium work?
Imodium reduces diarrhea by reducing gut contractions.
The active ingredient in Imodium is the drug called loperamide, which binds to opioid receptors in the gut. When this happens, there’s reduced production of a molecule called acetylcholine in the gut.
Under normal conditions, acetylcholine makes the gut contract from time to time, which allows food and water to pass along it and helps in digestion. If gut contractions reduce, you get constipation. If they increase, you experience diarrhea.
Since Imodium reduces acetylcholine concentration in the gut, it reduces gut contractions too. This allows the colon to reabsorb large quantities of water from the stool, preventing the formation of loose stools and treating diarrhea.
How many days in a row can you take Imodium?
Imodium can be taken for a maximum of two days in a row. If your diarrhea doesn’t resolve within 2 days, it might be caused by an infection, food intolerance, or a functional gut disorder like IBS. After taking Imodium for 2 days, you must consult a doctor if your diarrhea doesn’t resolve.
How is Imodium used?
Imodium comes both as a liquid and a tablet, and both forms are taken by mouth.
In most cases, Imodium shouldn’t be used for more than 2 days. However, you should be aware that a prescription form of the drug is available, which can be used for longer periods. Imodium is used long-term for diarrhea caused by inflammatory bowel disease (not irritable bowel syndrome).
The dosage of Imodium depends on your age and weight. For adults, it’s recommended to start the drug at 4 mg and follow it up with 2 mg after every loose stool. Make sure you don’t exceed 8 mg in a single day.
Is long-term use of Imodium harmful?
Unless prescribed by a doctor, long term use of Imodium can be harmful. Since IBS is a chronic disease, you may think it’s a good idea to take Imodium every day. It’s not. While Imodium is generally safe for most people, long-term use can lead to significant side effects. These include:
● Constipation — this is especially important if you have the mixed type of IBS, in which case Imodium can worsen the constipation phase significantly
● Allergic reaction, which is a severe side effect and is characterized by skin swelling and difficulty breathing. It can be fatal without immediate medical attention.
There’s also evidence that long-term use of Imodium can make it ineffective. For example, in a study, repeated doses of loperamide led to a reduction in its antidiarrheal effect in mice.
Then, Imodium can also interact with other medications. An interaction is when one drug alters the level of another drug in the body. Imodium can decrease the levels of some drugs in the body, making them ineffective. It can also increase the levels of other drugs, leading to drug toxicity and side effects.
Some drugs Imodium can interact with include:
● Saquinavir (an HIV drug)
You can see that some of these drugs — like saquinavir and the diabetes drug pramlintide — are often used for long-term, which means taking Imodium for long-term can increase the chance of interaction with these drugs.
Is it okay to take Imodium for IBS?
Yes, it’s okay to take Imodium for IBS.
If you have IBS-D, your doctor might prescribe an over-the-counter antidiarrheal like Imodium.
However, studies have shown that while Imodium may treat diarrhea, it’s not good at treating other symptoms associated with IBS. There are many symptoms of IBS other than diarrhea and these include:
● Abdominal pain
All of these symptoms need to be addressed via a holistic approach for successful treatment of IBS, which is something Imodium doesn’t achieve.
Plus, IBS is a chronic condition, which means your diarrhea is probably going to return. While Imodium will treat your current bout of diarrhea, it will not reduce the risk of future flares, which is why it’s important not to rely solely on the drug for IBS treatment.
Finally, many IBS patients also have lactose-intolerance, which is an independent cause of diarrhea. Lactose-intolerance occurs when the body lacks the enzyme to break down the sugar lactose, which is found in dairy foods.
Lactose-intolerance is treated by avoiding dairy foods — Imodium is unlikely to help.
How do you stop IBS diarrhea when Imodium doesn’t help?
IBS treatment can involve a variety of drugs apart from Imodium. Self-medication is never a good idea and it’s important to consult a doctor for medical treatment of IBS.
However, you can also take certain steps at home to ease IBS diarrhea and improve the overall symptoms of the condition. These include:
● Dietary modification — many IBS patients are intolerant to a class of sugars called FODMAPs. A low-FODMAP diet is a very popular treatment for IBS and you should try it out. It’s also a good idea to avoid foods that irritate the gut, which include chocolate, caffeine, carbonated drinks, and alcohol.
● Stress management — stress has been shown to play a role in triggering IBS symptoms and effective stress management can improve the condition. Cognitive behavioral therapy, hypnotherapy, and relaxation therapy are some of the options you have.
● Probiotic supplements — supplements containing Bifidobacterium may help with IBS. Before buying a product, discuss it with your doctor to make sure that it can be used in your case. Also, always buy supplements from a well-known company because unlike drugs, they’re not tightly regulated by the FDA.
● A healthy lifestyle — regular exercise, meditation, and good sleep hygiene can all reduce stress, which in turn can improve your IBS symptoms.