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Use of loperamide
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Use of loperamide

Posted By  HFHSM.D.-rf on January 30, 1998 at 22:39:26:

In Reply to: Use of loperamide posted by Michael on January 25, 1998 at 17:43:01:

: Dear sirs, I am a 31 year old male who had a colectomy and ileoanal j-pouch
  surgery in 1993.  This was due to severe colitis.  I find that when I use
  loperamide it lessens the frequency of bowel movements and I generally use
  it if I know I will be in a situation where bathrooms aren't very accessable.
  I've been trying to find out what kind of dosages are safe for extended
  periods of time.  Getting up 2-3 times a night to use the bathroom is a real
  pain in the neck and I rarely get a good night's sleep.  However, if it is
  safe to do so, I would love to be able to take perhaps 1 2mg pill a day to
  help me sleep at night, but I'm not going to try this until I have some real
  evidence that it would be ok.  If you know, or could point me in the right
  direction to someone who does, I would be eternally grateful.  
                                      Thank you, Michael Basta  
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Dear Michael Basta
Patients who have had a colectomy and ileoanal anastomosis often have an increased frequency of defecation of soft or usually liquid stool.  The diarrhea results from the loss of the colon.  Under normal circumstances approximately 600 ml of fluid enters the colon from the small intestine.  Most of this fluid is absorbed in the colon and approximately only 200 ml of stool is passed per day.  After the colon has been removed, however, this absorptive capacity is lost and whatever fluid leaves the small intestine is passed as feces.  
Using loperamide is safe and often effective treatment to relieve the diarrhea associated with colon removal. Taking loperamide before going to sleep should allow for a restful night.  In fact, loperamide can be used on a regular basis, so that you are able to perform your regular daytime activities, without the constant fear of diarrhea and incontinence.  For chronic diarrhea, you can start with a loperamide dosage of 1 tablet 2 or 3 times a day.  You can adjust the dosage (up or down) in order to obtain the frequency of defecation that you find acceptable.  You should not use more than 8 pills per day without consulting with your physician.  Some patients are very sensitive to the effects of loperamide and are well controlled with only 1 pill/day.  You will learn your requirements as you gain experience with the medication.
Although the bowel pattern that you describe may be the result of your colon resection, there are other diagnostic considerations.  1)
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