Issue No. 28
Date: November 2025
Concurrent use of laxatives and loperamide
Following an after action review relating to a case of C. difficile it’s been identified that a number of patients trustwide are prescribed loperamide at the same time as a laxative.
Whilst some medications such as codeine can sometimes be used to manage diarrhoea it is more often used as an analgesic, whereas loperamide acts within the bowel itself and has no other indications, so there are limited circumstances when concurrent use of laxatives is clinically appropriate.
Considerations for clinicians/prescribers
• When prescribing loperamide it’s always worth checking if patients are taking laxatives –remember that patients may buy their own
• Loperamide is generally only used on a when required basis, the exception being patients who need regular doses to manage high output stomas or chronic bowel conditions.
• If your patient does require regular loperamide dosing it’s worth documenting the reasons in the clinical notes, particularly if this is a new prescription.
Considerations for other staff groups
• If you see loperamide prescribed at the same time as laxatives, check if there is a reason documented in the notes or speak to the prescriber. Some patients may also be able to tell you if they regularly use both to manage their condition.
• For patients admitted on regular loperamide +/- laxatives this will be documented on the medicines reconciliation note on EPMA and/or in the clinical notes.
• Where there is a clear indication to have both loperamide and laxatives prescribed at the same time, consider adding this to the patient handover documents so that this information is readily available to the wide range of staff involved in the patient’s care.
• Always check before administering both medications together.