A Pharmacist's Guide to OTC Therapy: Antidiarrheal Products

Pharmacy Times
Volume 0

In general, acute diarrhea can be managed effectively with the use of nonprescription antidiarrheal products in conjunction with adequate fluid-electrolyte replacement and dietary interventions. Existing nonprescription antidiarrheal products contain loperamide or bismuth subsalicylate (Table).


Loperamide is indicated for traveler's diarrhea, nonspecific acute diarrhea, or chronic diarrhea associated with inflammatory bowel disease.1 The therapeutic effects include reduction of daily fecal volume, increased viscosity and bulk volume, and reduced fluid and electrolyte loss.

Loperamide should not be used by individuals with fecal leukocytes, high fever, or blood or mucus in the stool. Adverse effects associated with loperamide include dizziness and constipation.1 Typically, loperamide is not recommended for children under 6 years of age unless under the direct supervision of a physician.

Bismuth Subsalicylate

Bismuth subsalicylate is indicated for the treatment of mild nonspecific diarrhea. Patients should be advised that the use of this agent may cause discoloration of the tongue and stool. The use of this agent should be avoided in the following patient populations:

  • Patients with a history of salicylate allergies or those currently taking salicylate products
  • Patients with a history of ulcers or coagulation abnormalities
  • Patients with medical conditions such as arthritis, diabetes, or gout
  • Children or teenagers with or recovering from the flu or chickenpox


Prior to recommending any product for diarrhea, pharmacists should thoroughly assess the patient for possible contraindications and drug interactions. Pharmacists also should encourage patients to ensure that they maintain adequate hydration and monitor for signs of dehydration. Most importantly, patients should be reminded to immediately contact their health care provider if they experience any of the symptoms listed in the Box.

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Va.

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