Fluid and electrolyte repletion is the primary treatment for acute diarrhoea and gastroenteritis.

For details of oral rehydration see 9.2.1 Oral preparations for fluid and electrolyte imbalance.

A diagnosis of the cause of diarrhoea should be made before starting symptomatic treatment. Acute prescriptions should be restricted to 30 loperamide capsules or 20 codeine tablets.

NICE CG49 (2007) addresses the management of faecal incontinence. Prescribers are advised to review patient's medication and consider alternatives to drugs that might be contributing to faecal incontinence.

For advice about the use of antibiotics in gastroenteritis, refer to Gastro-intestinal tract infections in chapter 5 of the formulary.

Loperamide

• Capsules 2mg (£0.79 = 30 capsules)

Indications and dose

• Acute diarrhoea in adults
  • 4mg initially followed by 2mg after each loose stool (maximum 16mg in 24 hours)
• Chronic diarrhoea in adults
  • 4mg-8mg per day in divided doses, adjust to symptoms (maximum 16mg in 24 hours)

Notes

1. Loperamide oral solution^SF 1mg in 5ml was discontinued on 30th September 2022.
   1. If patients can swallow solid dosage forms, loperamide capsules remain available
   2. The Specialist Pharmacy Service suggest, if needed, capsules can be opened and the contents mixed with a small amount of water, jam, or yoghurt (off label).
2. For chronic diarrhoea, loperamide should be introduced at a very low dose and the dose should be escalated, as tolerated by the individual to achieve the desired stool consistency.

Codeine phosphate

• See section 4.7.2 Opioid analgesics

Indications

• Acute diarrhoea
• Chronic diarrhoea

Dose

• Acute diarrhoea: 30mg 3-4 times a day; dose range 15-60mg 3-4 times a day.