INDICATIONS     CONTRA-INDICATIONS     DOSAGE     SIDE-EFFECTS     PREGNANCY     OVERDOSE     IDENTIFICATION     PATIENT INFORMATION

Logo IMODIUM® CAPS capsules

SCHEDULING STATUS:
Schedule 2

PROPRIETARY NAME
(and dosage form):

IMODIUM® CAPS capsules

COMPOSITION
2 mg
loperamide hydrochloride per capsule.

PHARMACOLOGICAL CLASSIFICATION
A.11.9 Medicines acting on gastro-intestinal tract. Antidiarrhoeals.

PHARMACOLOGICAL ACTION
IMODIUM CAPS inhibits hypermotility by direct action on the bowel wall. Its inhibition of peristalsis is the result of decreasing the activity of both the longitudinal muscles (preparatory and reflex phases) and the circular muscles (reflex phase).
IMODIUM CAPS normalizes the stool in both acute and chronic diarrhoea.
IMODIUM CAPS is incompletely absorbed from the gut, and it is almost completely metabolized in the liver where it is conjugated and excreted via the bile. IMODIUM CAPS is mainly eliminated via the faeces.

INDICATIONS
Adults and children 6 years and older:
IMODIUM CAPS is indicated for the control and symptomatic relief of acute and chronic nonspecific diarrhoea and inhibition of peristalsis and slowing of intestinal transit time in patients with ileostomies, colostomies and other intestinal resections.
Children below 6 years of age: IMODIUM CAPS is indicated for inhibition of peristalsis and slowing intestinal transit time.

CONTRA-INDICATIONS
IMODIUM CAPS is contra-indicated in patients with a known hypersensitivity to the medicine.
IMODIUM CAPS is contra-indicated in infants under 24 months of age.
Since treatment of diarrhoea with IMODIUM CAPS is only symptomatic, diarrhoea should be treated causally, whenever causal treatment is available. IMODIUM CAPS should not be used as the primary therapy in acute dysentery, which is characterised by blood in stools and high fever.
IMODIUM CAPS must not be used in patients with acute ulcerative colitis or pseudomembranous colitis associated with broad-spectrum antibiotics. In general, IMODIUM CAPS should not be used when inhibition of peristalsis is to be avoided and must be discontinued promptly if constipation, abdominal distension or subileus develop. Loperamide administration may precipitate toxic megacolon in patients with inflammatory bowel disease.
The safety of use during pregnancy and lactation has not been established.

DOSAGE AND DIRECTIONS FOR USE
IMODIUM CAPS should not be used in infants under 2 years. The capsules, however, are not suited for children under 6 years of age.
Acute non-specific diarrhoea:
For adults and children of 6 years and older: 2 capsules (adults) or 1 capsule (children) as an initial dose followed by 1 capsule after each subsequent loose stool.
Do not exceed the following maximum daily dosages.

WEIGHT IN KILOGRAMS (kg) MAXIMUM DAILY DOSE
        from 14 kg         2 capsules
        from 20 kg         3 capsules
        from 27 kg         4 capsules
        from 34 kg         5 capsules
        from 40 kg         6 capsules
        from 47 kg         7 capsules
        from 54 kg         8 capsules

Important: As soon as diarrhoea is under control, stop dosage.
In acute diarrhoea, if clinical improvement is not observed within 48 hours, the administration of IMODIUM CAPS should be discontinued and patients should be advised to consult their doctor.
Chronic non-specific diarrhoea (consult your doctor):
With individually adjusted dosage it is usually possible to obtain a virtually normal bowel movement.
The initial dose is 2 capsules daily for adults and 1 capsule daily for children of 6 years and over.
The initial dose should be adjusted until 1–2 solid stools per day are obtained. This is usually achieved on a maintenance dose of 1–6 capsules.
If constipation occurs, the dosage should be decreased.

SIDE-EFFECTS AND SPECIAL PRECAUTIONS
Reversible paralytic ileus may occur at a high dose level.
Constipation and or abdominal distension, dry mouth, abdominal pain or discomfort and other gastro-intestinal disturbances (e.g. nausea and vomiting), drowsiness or dizziness and fatigue may occur.
Hypersensitivity reactions such as skin rash and urticaria and less frequently cases of anaphylactic shock and bullous eruption including Toxic Epidermal Necrolysis. Other medications may have caused or contributed to some of these cases.
Precautions:
In patients with diarrhoea, especially in infants, fluid and electrolyte depletion may occur. In such cases administration of appropriate fluid and electrolyte replacement (oral rehydration therapy [ORT]) is the most important measure. IMODIUM CAPS should not be given to children less than 6 years of age without medical prescription and supervision.
IMODIUM CAPS is not recommended for routine use in acute or chronic diarrhoea in children under the age of 6 years.
Patients with hepatic dysfunction should be monitored closely for signs of central nervous system toxicity because of the high first-pass metabolism.

KNOWN SYMPTOMS OF OVERDOSAGE AND PARTICULARS OF ITS TREATMENT
Overdosage may lead to constipation and depression of the central nervous system. Children may be more sensitive to central nervous system effects of loperamide than adults. Convulsions have been reported in children under the age of 2 years.
Excessive inhibition of peristalsis with nausea and dryness of the mouth.
Treatment is symptomatic and supportive. Naloxone can be given as an antidote. Since the duration of action of IMODIUM CAPS is longer than that of naloxone (1 to 3 hours) repeated treatment with naloxone may be indicated. Therefore, the patient should be monitored closely for at least 48 hours in order to detect possible central nervous system depression.

IDENTIFICATION
Opaque green cap and opaque dark grey body.

PRESENTATION
Cartons containing one or more blister packs of 6; 10; 12 or 20 capsules each.

STORAGE INSTRUCTIONS
Store below 25°C. Protect from light.
KEEP OUT OF REACH OF CHILDREN.

REGISTRATION NUMBER
U/11.9/213

NAME AND BUSINESS ADDRESS OF THE APPLICANT
JANSSEN-CILAG
Janssen Pharmaceutica (Pty) Ltd.
(Reg. No. 80/11122/07)
15th Road,
Halfway House 1685.
© JANSSEN PHARMACEUTICA (Pty) Ltd. SOUTH AFRICA

DATE OF PUBLICATION OF THIS PACKAGE INSERT:
26 February 1999.

                Code No.: 023799
                99H
                Britepak

® = TRADEMARK
Updated on this site: May 2000

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