Loperamide with simeticone

How it works

Loperamide acts on gut opioid receptors to slow intestinal motility and reduce stool frequency, while simeticone lowers the surface tension of gas bubbles to coalesce and disperse trapped intestinal gas, relieving bloating and flatulence.

Prescribing in practice

• As with loperamide alone, avoid in dysentery, suspected bacterial colitis with blood and fever, and active inflammatory bowel disease, where slowing motility risks serious complications including toxic megacolon.
• It is for short-term symptomatic use and does not replace oral rehydration, and the loperamide dose must not be exceeded because of the cardiac risks seen in overdose.
• Simeticone is essentially non-absorbed and inert, so the combination's cautions are driven principally by the loperamide component.

Monitoring

No routine monitoring is needed; review if symptoms persist beyond a short period or if blood, fever or abdominal distension develop.

Counselling the patient

• This combination eases both the diarrhoea and the trapped wind and bloating that can come with it.
• Keep up your fluid intake and stop and seek advice if you see blood in the stool, develop a fever, or the tummy becomes swollen.

Evidence & guidelines

The loperamide-simeticone combination is an established over-the-counter option for acute diarrhoea with associated bloating and gas.