Imodium
How it works
Slows intestinal motility and increases fluid/electrolyte absorption. First-line rescue for irinotecan-induced and mFFX delayed diarrhoea.
Rescue medication for irinotecan / mFFX diarrhoea — every mFFX patient should have loperamide on hand from cycle 1. Fever + diarrhoea at any time is a medical emergency (neutropenic enterocolitis); call oncology or attend ED immediately.
Dosing
Typical doses
- Standard: 4 mg at onset, then 2 mg every 4 h or after each loose stool (max 16 mg/day)
- High-dose for irinotecan: 4 mg at onset, then 2 mg every 2 h until diarrhoea-free 12 h
Schedule
- As neededprn
Side Effects
- •Constipation (rebound)
- •Abdominal cramping, distension
- Toxic megacolon — rare but life-threatening; watch for distension, fever, ileus
- Dehydration + electrolyte loss if diarrhoea severe (pre-loperamide risk)
- QT prolongation / cardiotoxicity at very high unsupervised doses
Monitoring
- Stool frequency + consistency; escalate to octreotide if Grade ≥3 diarrhoea > 24 h on loperamide + atropine-diphenoxylate
- FBC — exclude neutropenic enterocolitis (febrile neutropenia + diarrhoea is an emergency)