# Loperamide in Nigeria

Loperamide has 29 active NAFDAC registrations in our October 2026 copy of the register, from 28 registration holders; 25 further listings have lapsed.

- Source: https://ogbogwu.com/drugs/loperamide/
- Drug class: Opioid receptor agonist (peripheral) (Digestive Health)
- Also known as: Imodium, Anti-diarrhoea, Lopamide
- Prescription required: no
- On the WHO Model List of Essential Medicines
- Last updated: February 2026

## Price in Nigeria

As of October 2026, the only loperamide our sampled online pharmacies (HealthPlus, MedPlus and Supermart.ng) list is Imodium, at about ₦15,525. That is Imodium's price, not the molecule's: 29 loperamide brands are NAFDAC-registered and generic versions usually cost less, so ask a licensed pharmacy for a generic by name and check its NAFDAC number before you pay.

## What is Loperamide?

Loperamide, best known by its brand name Imodium, is one of the most widely used anti-diarrhoeal medications in Nigeria. It belongs to a class of drugs called peripheral opioid receptor agonists, which means it acts on opioid receptors in the wall of the intestine to slow down gut movement and reduce the frequency of bowel motions. Unlike other opioids, loperamide does not cross the blood-brain barrier in significant amounts at normal doses, so it does not cause the pain-relieving or addictive effects associated with drugs like tramadol or codeine. In Nigeria, where diarrhoeal diseases remain a leading cause of illness and death — particularly among children under five — loperamide is commonly purchased over the counter in pharmacies and patent medicine stores from Lagos Island to Kaduna, from Aba to Maiduguri.

Diarrhoeal diseases are a major public health challenge in Nigeria, driven by inadequate access to clean water, poor sanitation, food contamination, and overcrowded living conditions in many urban and rural areas. The WHO estimates that diarrhoea kills thousands of Nigerian children annually and causes millions of episodes of illness in adults. While loperamide is effective at reducing stool frequency and providing symptomatic relief in adults with acute non-specific diarrhoea, it is critically important to understand that it is NOT a first-line treatment for diarrhoea. The WHO and Nigerian health guidelines recommend oral rehydration salts (ORS) combined with zinc supplementation as the cornerstone of diarrhoea treatment, especially in children. Loperamide treats the symptom (frequent stools) but does not address the underlying cause or replace lost fluids and electrolytes.

Loperamide is available in Nigeria as 2mg capsules and tablets. Popular brands include Imodium (by Johnson & Johnson, the most recognised brand), alongside generic loperamide from a number of manufacturers. All legitimate products must carry a NAFDAC registration number. While loperamide is generally safe for short-term use in adults, it should NOT be used in cases of bloody diarrhoea (dysentery), diarrhoea caused by certain bacterial infections (such as Clostridium difficile), or in children under 6 years of age without medical supervision. In every case of diarrhoea, the priority should be preventing dehydration through adequate fluid intake and ORS, not simply stopping the diarrhoea with loperamide.

## What is Loperamide used for?

- Symptomatic relief of acute non-specific diarrhoea in adults — the most common reason Nigerians purchase loperamide, providing quick reduction in stool frequency
- Traveller's diarrhoea — commonly used by Nigerians travelling to or from different regions, and by visitors to Nigeria adjusting to local food and water
- Chronic diarrhoea management — used under medical supervision for conditions causing persistent loose stools, such as irritable bowel syndrome with diarrhoea (IBS-D)
- Reducing stool output in patients with ileostomies or other bowel surgeries
- Diarrhoea associated with food intolerance or dietary indiscretion — common in Nigeria where street food is widely consumed
- Adjunct to rehydration therapy in adults with acute watery diarrhoea (always alongside ORS, never as a replacement)

## Dosage

Always follow a doctor's or pharmacist's instructions; this is general reference information.

- Adults: For acute diarrhoea: Take 4mg (two capsules) as the initial dose, followed by 2mg (one capsule) after each loose stool. Maximum daily dose is 16mg (eight capsules) in 24 hours. For chronic diarrhoea: 4mg to 8mg daily in divided doses, adjusted according to response. Maximum daily dose remains 16mg. Treatment for acute diarrhoea should not exceed 48 hours. If diarrhoea persists after 48 hours of loperamide use, stop the medication and see a doctor.
- Children: Loperamide is NOT recommended for children under 6 years of age. For children aged 6 to 8 years (20 to 30kg): 2mg twice daily for up to 3 days. For children aged 9 to 12 years: 2mg three times daily for up to 3 days. However, in Nigeria, the WHO-recommended treatment for childhood diarrhoea is ORS and zinc — NOT loperamide. Parents should be strongly advised to use ORS and zinc for diarrhoea in children and seek medical attention if the child shows signs of dehydration.
- Elderly: Standard adult doses are generally appropriate for elderly patients. However, elderly patients should be closely monitored for signs of dehydration, as they are more vulnerable to fluid and electrolyte loss from diarrhoea. Rehydration with ORS or adequate fluids should always accompany loperamide use. Elderly patients with liver impairment may require dose reduction due to slower drug metabolism.

Loperamide should always be used alongside adequate fluid and electrolyte replacement — it stops the diarrhoea but does not replace the water, sodium, and potassium your body has lost. Take ORS or drink plenty of clean water, soups, and oral fluids while using loperamide. Do not exceed the recommended dose. In Nigeria, some people take excessive doses of loperamide believing it will work faster — this is dangerous and can cause serious heart rhythm problems. Stop taking loperamide and see a doctor if diarrhoea persists beyond 48 hours, if you develop fever, or if you see blood or mucus in your stools.

## Side effects

Common: Constipation — the most common side effect, occurring when the drug slows gut movement too much; Abdominal cramps and bloating; Nausea — usually mild and self-limiting; Dizziness — infrequent but may occur; Flatulence (gas).

Serious (seek medical help immediately): Paralytic ileus — a dangerous condition where the intestine stops moving entirely, causing severe abdominal distension, pain, and vomiting; this is more likely with overdose; Toxic megacolon — a life-threatening complication where the colon dilates dangerously; can occur if loperamide is used in cases of inflammatory colitis or Clostridium difficile infection; Cardiac arrhythmias — loperamide abuse at very high doses (far above recommended) can cause dangerous heart rhythm abnormalities including QT prolongation, ventricular tachycardia, and cardiac arrest; Severe allergic reaction — rare but includes rash, facial swelling, and difficulty breathing; Severe abdominal pain and distension — stop loperamide immediately and seek emergency care.

When to see a doctor: Stop taking loperamide and see a doctor immediately if your diarrhoea persists after 48 hours of treatment, if you develop blood or mucus in your stools (this could indicate dysentery, which requires antibiotic treatment), if you develop a high fever above 38.5 degrees Celsius, or if you experience severe abdominal pain or distension. Seek emergency care if you have signs of severe dehydration including sunken eyes, dry mouth, inability to drink, reduced urination, or extreme lethargy. In children, signs of severe dehydration also include absence of tears when crying and a sunken fontanelle (soft spot) in infants.

## Warnings

Do not take if: Do NOT use loperamide for dysentery (bloody diarrhoea with mucus) — this requires antibiotic treatment, not an anti-diarrhoeal; common causative organisms in Nigeria include Shigella, Salmonella, and Entamoeba histolytica; Do NOT use in cases of acute ulcerative colitis or Clostridium difficile-associated diarrhoea (antibiotic-associated colitis), as loperamide can trigger toxic megacolon; Do NOT use in children under 6 years of age — the WHO recommends ORS and zinc as the sole treatment for childhood diarrhoea in Nigeria; Do NOT use if you have abdominal distension, high fever, or signs of a serious intestinal infection; Use with caution in patients with liver disease (including hepatitis B and C, which are prevalent in Nigeria) as loperamide is extensively metabolised by the liver.

Interactions: Ritonavir and other HIV protease inhibitors — can significantly increase loperamide blood levels by inhibiting its metabolism; relevant in Nigeria where HIV treatment is widespread; Quinidine and other drugs that inhibit CYP3A4 or P-glycoprotein — can increase loperamide levels and potentially allow it to cross the blood-brain barrier, causing central nervous system depression; Gemfibrozil and itraconazole — may increase loperamide plasma concentrations; Oral desmopressin — loperamide may increase desmopressin absorption and its effects; Co-trimoxazole (Septrin) — commonly used in Nigeria; when combined with loperamide, monitor for increased loperamide effects.

Pregnancy & breastfeeding: Loperamide should be used during pregnancy only if clearly needed and the benefit outweighs the risk. While animal studies have not shown direct harm, there are limited human data. It is generally considered a safer option than many other anti-diarrhoeals during pregnancy, but ORS and adequate hydration should be the first approach for diarrhoea in pregnant women. Loperamide is excreted in breast milk in very small amounts. A single dose or short course is generally considered compatible with breastfeeding, but consult your doctor or pharmacist before use. For persistent diarrhoea during pregnancy, always seek medical advice.

## Brands in Nigeria

Well-known NAFDAC-registered brands: Imodium (Johnson & Johnson, made in Portugal).
Full searchable brand list: https://ogbogwu.com/drugs/loperamide/brands/

## How to verify it is genuine

1. Check for a valid NAFDAC registration number on the packaging — all loperamide products in Nigeria, whether imported or locally manufactured, must carry this number
2. Verify the NAFDAC number via the NAFDAC Green Book portal (www.greenbook.nafdac.gov.ng) or the official NAFDAC mobile verification app on Android and iOS
3. Purchase from licensed pharmacies or registered patent medicine stores — avoid buying anti-diarrhoeal medicines from unlicensed market vendors or roadside sellers
4. Inspect the packaging for clear manufacturer details, batch number, manufacturing date, and expiry date — all text should be legible with no smudging or spelling errors
5. For Imodium branded products, check for the Johnson & Johnson logo and consistent packaging quality — counterfeit versions often have slightly different colours or poor print quality
6. If the capsules or tablets look different from what you have previously used (unusual colour, size, or smell), do not take them and report to your pharmacist or NAFDAC

Verify any NAFDAC number free (no login): https://ogbogwu.com/nafdac-checker/

## FAQs

### Should I take loperamide or ORS for diarrhoea?

The most important treatment for any case of diarrhoea — whether in children or adults — is preventing and treating dehydration with oral rehydration salts (ORS) and adequate fluids. ORS replaces the water, sodium, potassium, and other electrolytes lost through diarrhoea. Loperamide and ORS serve different purposes: ORS treats dehydration (which is what actually kills people from diarrhoea), while loperamide reduces stool frequency for symptom relief. In adults with acute watery diarrhoea, loperamide can be used alongside ORS for comfort, but it should never replace ORS. For children under 6, loperamide should NOT be used at all — the WHO-recommended treatment is ORS plus zinc. In Nigeria, many people reach for loperamide first to 'stop the diarrhoea' while ignoring fluid replacement, which is dangerous. Always prioritise hydration.

### When should I NOT take loperamide?

There are several important situations where you should NOT take loperamide. First, do not use it if you have bloody diarrhoea (dysentery) — blood or mucus in the stool indicates an invasive infection that requires antibiotics, and loperamide can make it worse by keeping the infectious organisms in the gut longer. Second, do not use loperamide if you have a high fever alongside diarrhoea, as this suggests a serious infection. Third, never give it to children under 6 years. Fourth, do not use it for more than 48 hours without seeing a doctor. Fifth, avoid it if your diarrhoea started after taking antibiotics (it could be C. difficile colitis). In Nigeria, where dysentery caused by Shigella and amoebic infections are common, it is particularly important to distinguish between simple watery diarrhoea (where loperamide may help) and dysentery (where it can be dangerous).

### Can I take loperamide for food poisoning?

This depends on the type and severity of food poisoning. For mild food poisoning causing watery diarrhoea without blood, fever, or severe cramping, loperamide can provide symptomatic relief while your body fights off the infection. However, the priority in any food poisoning case should be staying hydrated with ORS or clean fluids. If your food poisoning involves bloody stools, high fever, severe abdominal pain, or persistent vomiting, do NOT take loperamide — these symptoms suggest a more serious infection that may require antibiotics. In Nigeria, food poisoning is common due to food hygiene challenges, especially with street food (suya, roasted corn, etc.) and improperly stored leftovers. If food poisoning symptoms last more than 2 days or are severe, visit a hospital or health centre rather than self-medicating.

## Sources

- NAFDAC Greenbook (official register of approved products in Nigeria)
- WHO Model List of Essential Medicines
- British National Formulary (BNF)
- Nigerian Standard Treatment Guidelines (Federal Ministry of Health)