Without a doubt, Imodium is the most popular brand used as a diarrhoea relief medication. Today’s post focuses on Imodium alternatives, drugs used in the treatment of diarrhoea.
What is diarrhoea?
Diarrhoea is a common condition characterized by loose, watery stools that occur more frequently than normal. It can be caused by a variety of factors, including bacterial or viral infections, food intolerances or allergies, medications, and certain medical conditions. Diarrhoea can affect children and adults of any age.
Diarrhoea can lead to dehydration, which can be especially dangerous in young children, elderly individuals, and people with weakened immune systems. It is important to stay hydrated and seek medical attention if symptoms persist or worsen. Treatment may involve oral rehydration therapy, medications to manage symptoms, or addressing the underlying cause of the diarrhoea.
Causes of diarrhoea
Acute diarrhoea is often caused by a “stomach bug”, but it can also be caused by an underlying condition and drugs. “Stomach bug” is a general term that is commonly used to describe a range of gastrointestinal illnesses that can cause symptoms such as nausea, vomiting, diarrhoea, abdominal pain, and cramping. A stomach bug is not a medical diagnosis but rather a common term used to refer to a variety of illnesses, including viral and bacterial infections. Some common examples of stomach bugs include norovirus, rotavirus, and food poisoning (bacterial infection).
These types of illnesses can be transmitted through contaminated food or water, close contact with an infected person, or poor hygiene practices. Stomach bugs can be highly contagious, and it is important to take measures to prevent the spread of infection, such as frequent hand washing and avoiding contact with others who are sick.
Traveller’s diarrhoea is a type of diarrhoea that can occur when travelling to certain parts of the world, particularly developing countries with poor sanitation and hygiene standards. It is caused by ingesting food or water that has been contaminated with bacteria, viruses or parasites.
The symptoms of traveller’s diarrhoea typically include:
- watery or loose stools,
- abdominal cramping,
- bloating, nausea,
- and sometimes fever.
The illness usually lasts for a few days but can sometimes last longer, especially if left untreated.
Travellers’ diarrhoea can often be prevented by practising good hygiene and food safety practices, such as washing hands frequently with soap and water, avoiding tap water, ice, and raw or undercooked foods, and choosing bottled water and food that has been cooked thoroughly.
Treatment for traveller’s diarrhoea may include rehydration with fluids and electrolytes to prevent dehydration, and sometimes antibiotics or anti-diarrhoeal medications, depending on the severity of the symptoms and the underlying cause of the illness.
People coming back from high-risk countries who experience symptoms of diarrhoea, together with other symptoms such as nausea, vomiting, fever, and bloody stools may be experiencing symptoms of travellers’ diarrhoea which can also be caused by the above organisms.
Common drugs that cause diarrhoea
Several drugs can cause diarrhoea as a side effect. Some of the common medications that can cause diarrhoea include:
1. Antibiotics: Antibiotics can disrupt the balance of bacteria in the gut, leading to diarrhoea. This is known as antibiotic-associated diarrhoea.
2. Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs such as ibuprofen and aspirin can irritate the lining of the stomach and intestines, leading to diarrhoea.
3. Laxatives: Laxatives are medications used to treat constipation, but they can also cause diarrhoea if taken in excessive amounts or for prolonged periods.
4. Antacids (especially magnesium-containing): Antacids are medications used to treat heartburn and acid reflux, but they can cause diarrhoea if taken in excessive amounts.
5. Chemotherapy drugs: Chemotherapy drugs can cause diarrhoea as a side effect, as they can damage the lining of the intestines.
6. Metformin: Metformin is a medication used to treat type 2 diabetes, but it can cause diarrhoea as a side effect in some people.
7. Proton Pump Inhibitors (PPIs) such as omeprazole or esomeprazole
8. Orlistat (weight loss medication)
Diarrhoea when to see GP
In most cases there is no need to see GP, however, certain people may need to see their doctor, for example:
- People with prolonged symptoms of diarrhoea
- People with prolonged changes in bowel patterns, for example, frequent episodes of diarrhoea
- Diarrhoea accompanied by persistent vomiting
- Prolonged, severe pain in the stomach
- People who travelled abroad to high-risk countries located in Africa, Asia, the Middle East, and South America and developed symptoms of diarrhoea (traveller’s diarrhoea)
- Yong children (infants) with symptoms of diarrhoea longer than one day
- Presence of blood in the stools
- Black or dark stools, which may be a sign of bleeding from the stomach
Self-care measures during an acute episode of diarrhoea
Diarrhoea usually goes on its own and lasts about 5-7 days in adults. It is important to drink plenty of fluids to avoid dehydration. Other recommendations include rest, eating normally when possible, and if fever is present, use of paracetamol.
Children and adults over 12 years of age have the option to use diarrhoea relief drugs such as Imodium or equivalent drugs.
Imodium range includes:
- Imodium Original capsules
- Imodium IBS relief
- Imodium instants: dissolve on the tongue, suitable ‘on the go’
- Imodium Plus Comfort tables: a combination of loperamide and simeticone, which relieve diarrhoea and help with other symptoms such as bloating, wind and cramps.
Imodium alternative drugs
The main active ingredient of Imodium is loperamide hydrochloride. Each capsule or tablet contains 2mg of loperamide hydrochloride.
Loperamide can be purchased over the counter in most supermarkets, pharmacies and online. When purchased outside the pharmacy counter loperamide is limited in size to 6 capsules or tablets per pack. Larger packs / multiple-packs of loperamide can be purchased from a pharmacy or online chemists.
The best Imodium alternatives: Generic loperamide 2mg capsules
Most supermarkets and pharmacies sell their own branded diarrhoea relief products, for example:
- Boots Diarrhoea Relief 2mg Capsule
- Tesco Diarrhoea Relief Capsules
- Morrisons Acute Diarrhoea Relief Capsules
- Diah-Limit (Coop Pharmacy)
- Lloyds Pharmacy Diarrhoea Relief Capsules
All of the above products contain 2mg of loperamide and are equivalent to Imodium Original capsules. There are plenty of other ‘generic’ loperamide capsules (not listed here) stocked by pharmacies and easily accessible to customers.
The main advantage over Imodium Original capsules is the price. Prices for generic loperamide capsules vary between supermarkets and pharmacies, but generally, a pack of 6 capsules costs from anywhere around £1 to just under £3.
Where to buy generic loperamide cheaply
Fortunately for customers, loperamide is available online with some great offers for multi-pack purchases. Below are some of the cheapest deals found on Amazon.co.uk for loperamide capsules.
Independent pharmacies generally sell cheaper than Imodium different generic and branded capsules of loperamide.
Additionally, pharmacies may stock cheap generic loperamide in the dispensaries. Loperamide is usually dispensed in a pack of 30 capsules. Some generic brands of loperamide 2mg are licensed as P medicines, which means they can be sold to the public. Not all pharmacies sell P stock especially when other brands are offered to the public in the shop area. A pack of 30 loperamide 2mg capsules including a markup cost is below £2. Patients who wish to choose this option for buying cheap loperamide need to ask a member of a pharmacy team if they would sell a ‘bigger’ pack of generic loperamide capsules from the dispensary.
Imodium alternatives: orodispersible loperamide
Imodium comes in form of orodispersible tablets called Imodium Instants and Imodium Instants Melts. The only difference between both products is the pack size and availability for the purchase.
Imodium Instants are general sale item, available for self-selection by customers from supermarkets or pharmacies with a limit of 6 tablets per pack, whereas Imodium Instants Melt is pharmacy-only medication available in large size packs of 12 or 18 tablets.
Orodispersible tablets dissolve in the mouth when placed on the tongue without the need for liquid. As with previous products, Imodium Instants contain loperamide 2mg.
Orodispersible Imodium is also available as a cheaper ‘generic’ product, for example, independent pharmacies may sell Numark Diarrhoea Relief Instants 2mg which is an equivalent form of orodispersible loperamide. Numark Diarrhoea Instants tablets are also available on Amazon.co.uk
Boots Diarrhoea Relief Instant-Melts
Boots Diarrhoea Relief Instant-Melts can be purchased from Boots chemists on the high street, and online. Boots Diarrhoea Relief Instant-Melts contain 2mg of loperamide.
Imodium alternatives: Imodium Plus and Imodium Plus Comfort tablets
Imodium Plus Comfort tablets contain two active ingredients, namely loperamide and simeticone. Imodium Plus Comfort tablets are general-sale item available in a pack size of 6 tablets from supermarkets, pharmacies and online, whereas larger packs of Imodium Plus tablets are restricted to sale from pharmacies only.
There is no alternative product which contains the same two active ingredients, however, simeticone can be purchased as an individual product, which can be taken alongside loperamide capsules.
Two brands of simeticone gel capsules which are commonly available in supermarkets and online are WindSetlers and Wind-eze. Both products are used to help with wind, bloating, and flatulence.
Imodium alternatives: rehydration treatment
Electrolytes are often used for the management of diarrhoea because they can help to replenish the body’s fluids and minerals that are lost during episodes of diarrhoea. When a person has diarrhoea, they can lose significant amounts of water, salts, and minerals, which can lead to dehydration and electrolyte imbalances.
Electrolytes are substances that carry an electric charge when dissolved in water, and they play important roles in many bodily processes. The most important electrolytes in the body include sodium, potassium, chloride, calcium, and magnesium.
Electrolyte solutions, also known as oral rehydration solutions (ORS), are specially formulated to replace the electrolytes and fluids lost during diarrhoea. These solutions typically contain a precise balance of water, salt, and sugar, which helps to optimize absorption and minimize dehydration.
ORS solutions are typically available over-the-counter at most supermarkets and pharmacies. They are also available in pre-packaged powder form, which can be mixed with water to make a solution.
ORS solutions are typically recommended for individuals who are experiencing mild to moderate diarrhoea.
Self-help management advice on the management of an acute episode of diarrhoea involves drinking plenty of water or rehydration products, which contain electrolytes to improve rehydration and replace electrolytes loss caused by diarrhoea. Dioralyte is one of the most known brands of rehydration sachets. The Diarolyte range comes in different flavours, all providing for the effective replacement of electrolytes to treat dehydration. Dioralyte can be used alongside loperamide.
Dioralyte Relief sachets contain pre-cooked rice, which helps watery stools return to normal.
Dioralyte has been out of stock for most of 2022 and has not been back in stock since.
O.R.S Hydration Tablets with Electrolytes are the best-selling product on Amazon.co.uk in the related category. Although not advertised specifically as oral rehydration for symptoms of diarrhoea, O.R.S Hydration Tablets are perfectly suitable to provide electrolytes and improve hydration. Additionally, O.R.S Hydration Tablets are vegan, gluten and lactose-free.
SOS Hydration is a brand of hydration products that are designed to help replenish fluids and electrolytes in the body. The brand offers a range of products such as hydration powders, drinks, and tablets that are formulated to help combat dehydration and the symptoms that come with it, such as fatigue, headaches, and dizziness. The products are typically marketed towards athletes, travellers, and anyone who is looking for an easy and convenient way to stay hydrated. The company claims that its products are scientifically formulated to provide the perfect balance of electrolytes and hydration to help maintain optimal health and performance.
Kaolin & Morphine Mixture for diarrhoea
Kaolin & Morphine Mixture is a pharmacy-only product that has been used as a ‘traditional’ remedy for the relief of diarrhoea. Kaolin is believed to help to remove ‘toxins’ which cause diarrhoea. One of the most common side effects of morphine is constipation, therefore this is a logical approach for the use
Kaolin is a type of clay that is used as an absorbent to bind with the excess water in the intestines and form a protective coating over the irritated lining of the gut. This helps to reduce the frequency and severity of diarrhoea.
Morphine, on the other hand, is an opioid analgesic that can reduce the contractions of the intestinal muscles, which can help to reduce the speed of stool passage through the intestines and alleviate the symptoms of diarrhoea.
Kaolin & Morphine Mixture is not commonly stocked by pharmacies. One would need to ask if this product is sold by the pharmacy.
Prescription-only alternatives to Imodium
Codeine phosphate for acute diarrhoea
Codeine phosphate can be prescribed by a doctor to treat symptoms of diarrhoea in adults and children over 12 years of age.
Codeine is an opioid analgesic that can be used to treat diarrhoea. It works by reducing the contractions of the intestinal muscles, which can help to slow down the movement of stools through the intestines, allowing the body more time to absorb water and nutrients from the food.
In addition, codeine can also help to increase the amount of water that is absorbed by the body, which can help to reduce the frequency and severity of diarrhoea.
However, it is important to note that codeine can be habit-forming and may cause side effects such as drowsiness, nausea, and constipation, so it should only be used under the guidance of a healthcare professional. Additionally, codeine is not typically used as a first-line treatment for diarrhoea, and other treatments, such as rehydration and changes in diet, are often recommended first.
Co-phenotrope as an Imodium alternative
Co-phenotrope is a prescription-only medication that is used to treat diarrhoea. It is a combination of two active ingredients: diphenoxylate and atropine.
Diphenoxylate works by slowing down the movement of stools through the intestines, which can help to reduce the frequency and severity of diarrhoea. It does this by binding to the opioid receptors in the gut, which can help to reduce the contractions of the intestinal muscles.
Atropine is added to co-phenotrope to counteract some of the potential side effects of diphenoxylate, such as drowsiness and slowed breathing. Atropine also has some antispasmodic effects on the gut, which can help to further reduce the symptoms of diarrhoea.
Co-phenotrope is usually taken orally in tablet form, and the dosage and frequency of use will depend on the severity of the diarrhoea and the individual’s response to the medication.
Rifaximin for travellers’ diarrhoea
Rifaximin is a medication that is used to treat bacterial infections in the gut, particularly those caused by certain strains of bacteria such as Escherichia coli and Clostridium difficile. It works by inhibiting bacterial RNA synthesis and thereby preventing the bacteria from multiplying and spreading.
Rifaximin is a type of antibiotic that is not absorbed into the bloodstream, which means that it acts locally in the gut and does not affect the normal bacterial flora elsewhere in the body. This is because rifaximin has a low bioavailability, which means that it is not well absorbed into the bloodstream when taken orally.
By selectively targeting the bacteria in the gut, rifaximin can help to reduce the symptoms of gastrointestinal infections such as diarrhoea, abdominal pain, and bloating. It is often used to treat conditions such as traveller’s diarrhoea, irritable bowel syndrome (IBS), and small intestinal bacterial overgrowth (SIBO).
Patients have a good choice of Imodium alternatives. Loperamide, the generic version of Imodium is widely available online, from supermarkets and pharmacies. It is important to recognise any prolonged changes in bowel habits and see a GP if ongoing symptoms are present.