Loperamide Alternatives: Over The Counter Substitutes

Last Updated: December 18, 2019

Authored by Olivier George, Ph.D.

Imodium (loperamide) is an over-the-counter medication that is designed to stop diarrhea. While it is a drug that is proven effective, users should also consider Imodium alternatives. It is possible that another OTC medication other than loperamide will be best.

Why Is Loperamide OTC?

Imodium medicines are sold over the counter in the United States and many countries around the world. However, some question why loperamide OTC sales are allowed. This is because loperamide, the central ingredient in Imodium, is an opiate, a drug class that includes everything from codeine to heroin.

Since those drugs are not allowed to be sold OTC, or at all, it leads many to wonder why loperamide gets a free pass. Ultimately, Imodium OTC formulations do not contain enough medication in a therapeutic dose to cross the blood-brain barrier, which is required for a drug to produce a high. However, addicts are known to take it in large doses to force the blood-brain barrier breach, something that the FDA is aware of and could result in restrictions on sales.

Due to it being an opioid, as well as other concerns, many people would prefer to use an Imodium alternative. However, these are not without their own problems.

Common Imodium Alternatives

There are numerous alternatives to Imodium tablets, gel caps, liquids, and chewables on the market. It is important that when considering these options, users do not assume that they are completely safe just because they are available OTC. Just as with loperamide interactions and side effects, other medications can also be problematic. This should be considered before using any Imodium alternative.

Imodium vs Pepto-Bismol

imodium alternative: loperamide vs pepto bismolPerhaps, the most well-known Imodium alternative is Pepto-Bismol. In fact, it is probably better known than Imodium itself given it has been around since 1900 and has a highly recognizable pink color. When comparing Imodium vs Pepto-Bismol, there are a few things to consider.

Active ingredients

The first is their active ingredients. While loperamide is an opiate, bismuth subsalicylate is simply an antacid. This can feel much safer to users who are comparing Imodium and Pepto.


The next is what these two medications treat. Both Pepto and Imodium treat diarrhea. However, when comparing the original formulas of each medication to each other, Pepto also treats a lot more. With Pepto, users can address upset stomach, heartburn, nausea, and indigestion as well.

However, Pepto is known to cause some strange side effects, including potentially turning the tongue black temporarily. It also does not work very long when compared to how long loperamide stays in the system. Ultimately, when deciding to take loperamide or Pepto, there is no universal answer.

Lomotil vs Imodium

Lomotil is another Imodium alternative, this time containing the active ingredients diphenoxylate hydrochloride and atropine sulfate. Just as with loperamide, it is strictly meant to treat diarrhea. However, there are a few key differences.

The first, and perhaps most important, is that Lomotil is not available OTC. It is a controlled substance in the United States because its chemical formula is very similar to that of the narcotic analgesic meperidine. It is considered to have a much higher potential for abuse than Imodium. As a result, when weighing Lomotil vs. Imodium, unless the diarrhea is serious enough to warrant a doctor’s visit, Lomotil will not be an option.

Another consideration with Lomotil vs loperamide is that Lomotil has significantly more side effects and known interactions. As for deciding between Lomotil and Imodium during pregnancy, both are considered to carry the same risks.

Kaopectate vs Imodium

Kaopectate is loperamide alternative that is available OTC. It has the same active ingredient as Pepto-Bismol, and thus treats the same conditions and comes with the same concerns. When comparing it with loperamide OTC, it interacts with fewer medications but is contraindicated for more medical conditions. Anyone with Reye’s Syndrome or coagulation problems will be better off with Imodium OTC.

Questran vs Loperamide

kaopectate vs imodium for diarrheaQuestran can be used as an Imodium alternative. However, it is not available OTC. It is actually a prescription medication meant to lower cholesterol. During studies, researchers found it has an effect on bile acid that can alleviate chronic diarrhea. As such, if someone is battling acute diarrhea, this is not an ideal loperamide OTC alternative. But if their diarrhea is chronic, they should consider asking their doctor about Questran over Imodium OTC.

Lotronex vs Loperamide

Finally, Lotronex is another Imodium alternative for chronic diarrhea, precisely that associated with irritable bowel syndrome. It is known to have significant adverse side effects, which can prevent it from being a good alternative for those using loperamide OTC. It is available by prescription only and cannot be used in children.

When Considering Loperamide Alternatives

Many Imodium alternatives are only available by prescription. This means that even gaining access to them will require a doctor’s visit. However, users should consult with a doctor before using any medication, even loperamide OTC.

All medications will have side effects and interactions, and it can be difficult for users to understand these on their own. The risks are greater in certain populations, that is why Imodium AD for children and its alternatives can be particularly risky. If a doctor is not available and the medication is needed urgently, speak to the pharmacist before taking Imodium OTC and its alternatives.

Be Cautious With Loperamide Alternatives

Because there is potential for abuse with Imodium and some of its alternatives, users should exercise caution. Anyone who feels an urge to abuse these drugs should seek help. Rehabilitation centers know how to get users clean and back on their feet. Their addiction treatment programs can be adjusted to the needs of a particular patient to ensure their long-standing recovery.

Page Sources

  1. Johnson PC, Ericsson CD, DuPont HL, Morgan DR, Bitsura JA, Wood LV, Comparison of loperamide with bismuth subsalicylate for the treatment of acute travelers' diarrhea, https://www.ncbi.nlm.nih.gov/pubmed/3944976
  2. Loperamide Compound Summary, https://pubchem.ncbi.nlm.nih.gov/compound/Loperamide

Published on: May 6th, 2019

Updated on: December 18th, 2019

About Author

Olivier George, Ph.D.

Olivier George is a medical writer and head manager of the rehab center in California. He spends a lot of time in collecting and analyzing the traditional approaches for substance abuse treatment and assessing their efficiency.


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