Imodium And Alcohol And Other Imodium Interactions

Last Updated: July 30, 2021

Authored by Olivier George, Ph.D.

Reviewed by Michael Espelin APRN

Imodium is the commonly known brand form of the synthetic phenylpiperidine opioid anti-diarrheal drug Loperamide. Since 1976, Loperamide has been used to treat various forms of diarrhea such as traveler’s diarrhea, chronic diarrhea of Irritable Bowel Syndrome (IBS), acute nonspecific diarrhea in children older than two years of age and adults. It has also seen use in reducing ileostomy output as well as managing chemotherapy-related diarrhea. Due to its wide spectrum of use against many types of diarrheal disease, it is among the most frequently used over-the-counter drugs. As such the risk of Imodium interactions with other drugs and substances is quite high. These interactions may alter the way that Immodium or the drug it comes into interaction with works and may result in unpredictable consequences. The consequences could include failure of the desired therapeutic outcome, an increase in the severity of experienced Loperamide side effects, or even worse, a reaction that could be toxic to the patient’s health.

Therefore, it is important for patients to have information regarding various important Imodium interactions and on what not to take with Imodium to avoid possible complications.

The Dangers of Combining Imodium And Alcohol

Although no absolute contraindication exists for combining the use of Imodium and alcohol together, it is best to avoid consuming alcohol during Loperamide treatment. This might be slightly confusing to some, as both alcohol and Loperamide through their mechanisms of action have the ability to function as Central Nervous System (CNS) depressants, and logically their combination would produce significantly depressed mentation. The absence of an absolute contraindication is because of the fact that at therapeutic doses, Loperamide is unable to cross the blood-brain barrier and reach the central nervous system in order to produce CNS depression due to an efflux mechanism.

However, if supra-therapeutic doses are taken such as with recreational misuse and addiction or certain drugs that inhibit the efflux mechanism which prevents Loperamide from entering the central nervous system are co-prescribed, Loperamide will produce CNS depression. In such a case, the combined use of Imodium and Alcohol together will produce compounded symptoms of Central Nervous System depression.

Side Effects Of Combining Imodium And Alcohol

In the case of the above mentioned scenario when high doses are taken or when its use is combined with those drug groups which inhibit the efflux mechanisms that keep it out of the Central Nervous System, combining Imodium and Alcohol will produce Central Nervous System depression.

This will manifest as a heightening of the shared CNS side effects of both Imodium and Alcohol:

  • Dizziness
  • Drowsiness
  • Somnolence
  • Difficulty concentrating
  • Confusion
  • Impaired thinking

As such it is best to avoid imbibing alcohol while taking Imodium to minimize any possible health risk. Furthermore, if patients do decide to drink while taking this medication it is recommended that they avoid tasks that require high alertness such as driving until they know how Loperamide affects them after drinking.

The Dangers of Combining Imodium And Alcohol.

What not to take with Imodium

As with all medications, there are a few drug groups that patients should avoid when taking Loperamide for their diarrheal disease to minimize the risk of complications.

  • Central Nervous System Depressants Similar to alcohol, patients should avoid combining any drugs that have potential CNS depressant effects with Loperamide, at least until they know how this medication affects them. These drugs could include opioids, benzodiazepines, barbiturates, anesthetics, certain anticonvulsants, first-generation antihistamines, and many more.
  • Other Antidiarrheals As Imodium already decreases transition time in intestines and inhibits peristalsis, its use should not be combined with other agents which have similar effects such as Diphenoxylate, Codeine, or Atropine as this could produce constipation or even ileus.
  • Arrhythmogenic Drugs This medication has been shown to be cardiotoxic and is capable of producing dysrhythmias and conduction abnormalities such as QT/QTc interval prolongation, Torsades de pointes( type of life-threatening arrhythmia), Ventricular tachycardia, and other ventricular arrhythmias. As such, drug groups like certain antipsychotics, antiarrhythmics, tricyclic and other antidepressants, and antihistamines that have the possibility to cause such arrhythmias and conduction abnormalities should not be used concomitantly.
  • Inhibitors of Hepatic Metabolism Other groups of drugs that should not be used in conjunction with this medication are those which inhibit its metabolism. Loperamide is metabolized by hepatic cytochrome P450 enzymes, specifically CYP3A4 and CYP2C8. Two drugs that are commonly encountered and which inhibit these two enzymes are Itraconazole used to treat fungal disease and Gemfibrozil used to lower blood lipid levels respectively. If the metabolism of Loperamide is inhibited, it will accumulate in systemic circulation and cause side effects associated with acute toxicity.
  • P-glycoprotein Inhibitors Yet another group of drugs with which Loperamide should not be combined are P-glycoprotein inhibitors. This glycoprotein is the “efflux pump” which prevents it from crossing the blood-brain barrier and producing similar CNS effects to opioids. Drugs that inhibit P-glycoprotein include Quinidine, Ritonavir, and Itraconazole to name a few.
  • Synthetic Vasopressin Analogs This medication should also not be used in conjunction with Desmopressin, a medication commonly used in diabetes insipidus, bedwetting, hemophilia A, von Willebrand disease, and high blood urea levels.  It increases the plasma levels of Desmopressin and can lead to toxicity presenting with abdominal pain and headaches.
  • Antiretrovirals The combination of this drug with Saquinavir, which is often employed in HIV/AIDs, should also be avoided as it decreases the therapeutic efficacy of saquinavir.

Imodium Interactions With Other Medications

Many people take other over-the-counter or prescription medicines along with Loperamide. Certain drugs may be taken to imitate the effects of Imodium Multi-Symptom Relief caplets or boost the effectiveness of the medication. While many interactions can be beneficial, some can pose a serious threat to a person’s health. It is essential to have information about the most frequent Imodium interactions with other substances and consult with a medical doctor before changing the dose or introducing new medicines alternative to Imodium.

Can you take Imodium with Pepto?

Pepto or Pepto-Bismol is the brand name of Bismuth subsalicylate that can be used to treat gastrointestinal complaints such as nausea, heartburn, indigestion, upset stomach, and diarrhea. As one can see, Imodium and Pepto can both be used to treat diarrhea. However, Loperamide is a much more efficacious agent in treating diarrhea than Bismuth subsalicylate.

Now to answer the question of can you take Imodium with Pepto? Yes, one could combine the use of Imodium and Pepto as there is no drug-drug interaction present between these two medications. However, just because one is able to combine these two medications, does not mean that one should. Combining these two agents would serve no purpose, furthermore combining two antidiarrheal agents could possibly lead to constipation. As such, although combining Imodium with Pepto is relatively harmless, it is best avoided.

Imodium And Antibiotics

The question of whether a person can take Imodium with antibiotics periodically arises since diarrhea is a side effect of many antibiotic medications. The drug-drug interaction between Imodium and antibiotics is mostly safe, with the exception of co-trimoxazole. Co-trimoxazole is another name of the antibiotic Trimethoprim/sulfamethoxazole (TMP/SMX), which can be used to treat a variety of bacterial infections. This antibiotic inhibits the metabolism of Loperamide and can increase its plasma levels, which can very rarely cause acute toxicity.

Another consideration with regard to Imodium and Antibiotics is the safety of Loperamide use in certain types of bacterial diarrhea. Generally, antidiarrheals are contraindicated in infectious diarrhea as they inhibit the intestine’s ability to eliminate toxins, which can lead to various medical complications. Thus, although no drug-drug interactions exist between Loperamide and antibiotics outside of the one example mentioned above, the use of Imodium with antibiotics should not be undertaken as Loperamide use is contraindicated in infectious diarrhea.

Imodium Interactions With Other Medications.

Safe Use Of Loperamide With Other Drugs

Specific Loperamide drug interactions can lead to serious health conditions and even death. The most hazardous medicines include opioid pain medications and medicines that affect the heart rhythm.

Some substances can increase the effectiveness of loperamide and subsequently lead to Loperamide overdose. Overdosing on loperamide can be fatal. It is especially common among those who are dissatisfied with how long Loperamide’s effects last. Extremely high doses of Loperamide can lead to severe liver problems, vomiting, and heart attacks.

An individual should avoid using loperamide to treat diarrhea associated with antibiotic treatment. When it comes to other drugs, it is crucial to research information about potential interactions before taking medicines alongside loperamide. If a person experiences persistent side effects during short-term treatment for mild diarrhea, it is advisable to receive medical consultation. A doctor can prescribe an alternative to any of the conflicting drugs and help avoid long-lasting and dangerous symptoms. If a patient misuses the medication, it is vital to reach drug rehabilitation facilities as soon as possible to get the proper treatment.

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Published on: May 6th, 2019

Updated on: July 30th, 2021

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.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.