“Loperamide” or “Montmorillonite Powder”, which should I choose for antidiarrheal?

For medical professionals only

The same is an antidiarrheal drug, what is the difference in application?

Loperamide and montmorillonite powder are commonly used antidiarrheal drugs in clinical practice, and both have good antidiarrheal effects. So, if you encounter a patient with diarrhea, can you choose which one?

In fact, this is not the case. Although both have good antidiarrheal effects, they have different mechanisms of action and cannot replace each other.

Next, let’s look at a case:

Case Sharing

The patient, male, 81 years old, developed fever, mild abdominal pain, 5-7 times a day with watery yellow stools, and no mucus, pus and blood in the diarrhea after catching a cold at night three days before the onset of the disease. , No tenesmus, no dizziness, nausea, vomiting, self-administration of berberine tablets for 3 days, no relief of symptoms.

Have a history of “hypertension and cerebral insufficiency” for more than 20 years.

Physical examination: body temperature 37.4°C, pulse 74 beats/min, respiration 16 beats/min, blood pressure 135/70mmHg. Consciousness, good general condition, normal heart and lungs; flat and soft abdomen, negative Murphy’s sign, slight tenderness around the umbilicus, no rebound tenderness, liver and spleen under the ribs, no tenderness at McBurby’s point, bowel sounds 10 times/ point.

Diagnosis: Acute enteritis.

Give norfloxacin capsules 0.2g, 3 times a day, and loperamide 4mg orally, the abdominal pain is relieved, but dilution is still not enough. Form 2-3 times.

The patient had a fever of 38°C on the 2nd day after treatment, and was given levofloxacin injection 0.2g, intravenous drip, and loperamide 4mg, orally.

On the 3rd day, the patient developed abdominal distension, aggravated abdominal pain, no defecation, and bowel sounds 1-2 times/min.

The emergency was transferred to a higher-level hospital, and the diagnosis was: Paralytic ileus. Considered to be due to loperamide. After continuous gastrointestinal decompression, fluid replacement and other symptomatic treatment, the patient recovered and was discharged.

This case is a patient with acute bacterial enteritis with moderate or above fever. It is not suitable for doctors to choose loperamide to relieve diarrhea, which leads to paralytic ileus. In this case, montmorillonite powder should be selected to stop diarrhea.

So, the question is, What is the difference between loperamide and montmorillonite powder? How to choose if diarrhea occurs? What precautions should be taken when using it? Today, I will tell you one by one!


The mechanism of action is different


Loperamide is chemically similar to haloperidol and pethidine, but the therapeutic dose has no effect on the central nervous system. The effect on intestinal smooth muscle is similar to that of opioids, which can inhibit the contraction of intestinal smooth muscle and reduce intestinal peristalsis; it can reduce the release of acetylcholine from the nerve endings of the intestinal wall, and directly inhibit the local interaction of cholinergic and non-cholinergic neurons. Peristaltic reflex; it can also prolong the residence time of food in the small intestine, promote the absorption of water, electrolytes and glucose, and inhibit the excessive secretion of prostaglandins, cholera toxins and other enterotoxins in the intestine.

In addition, loperamide increases the tone of the anal sphincter muscle, which can inhibit fecal incontinence or urgency.

▎Montmorillonite Powder:

Montmorillonite powder is a natural montmorillonite particle powder with a layered structure and non-uniform charge distribution. It has strong effects on viruses, bacteria and their toxins in the digestive tract. Fixing and inhibiting effects make it lose its pathogenic effect; in addition, it has a strong covering and protection ability on the digestive tract mucosa, repairs and improves the defense function of the mucosal barrier against attacking factors, and has the effect of balancing normal flora and local pain relief. After taking it, bacteria, viruses and toxins that can cause diarrhea are absorbed and excreted with feces.


Loperamide should not be used for infectious diarrhea


Loperamidebest suited for functional diarrhea—such as irritable bowel syndrome with diarrhea, not for acute bacterial enteritis Or infectious diarrhea such as acute bacillary dysentery.

Because in infectious diarrhea, the pathogen can be excreted by increasing the number of bowel movements. Taking loperamide at this time will reduce defecation and cause pathogens to remain in the body, which may cause severe poisoning symptoms, such as high fever, abdominal pain, abdominal distension, confusion, and even shock.

Loperamide in patients with ileostomy reduces the volume and frequency of bowel movements and increases stool consistency.

Loperamide is used in patients after anorectal surgery to suppress bowel incontinence.

▎Montmorillonite Powder:

A wide range of applications, has a good effect on acute viral, bacterial enteritis and acute bacillary dysentery . However, it should be noted that effective antibiotics should be added for acute bacterial enteritis and acute bacterial dysentery.


Loperidine is contraindicated in these patientsAmine


It is contraindicated in patients with allergy to loperamide, patients with allergic constitution, food and drug allergy history and family history, and patients with severe liver damage should be used with caution.

Loperamide is contraindicated in children under 2 years of age, in acute bacillary dysentery accompanied by high fever and pus and bloody stool, in patients with intestinal obstruction, megacolon and toxic megacolon. It is contraindicated in patients with pseudomembranous colitis caused by broad-spectrum antibiotics.

▎Montmorillonite Powder:

Contraindications are unclear.


Notes vary


Should not be used in patients who need to avoid suppressing bowel movements, especially those with bowel obstruction, flatulence, or constipation.

Loss of water and electrolytes is common in patients with diarrhea and should be replenished appropriately. The course of oral loperamide should also be shortened as much as possible to achieve “diarrheal drug stop”, otherwise paralytic ileus may easily occur. If constipation occurs during the medication or if it is still ineffective within 48 hours, the medication should be discontinued.

Fatigue, dizziness, or drowsiness may occur during treatment for diarrhea, so be careful while driving and operating machinery.

Loperamide is completely metabolized by the liver. People with liver dysfunction may lead to a relative overdose of the drug in the body. Attention should be paid to the central nervous system toxicity. It should be used with caution in pregnant and lactating women; under 5 years old Children should not use it; elderly patients with habitual constipation should be used with caution, and the dosage should be carefully controlled. Overdose may cause symptoms of drowsiness, constipation, muscle tension, mydriasis, slow breathing and other poisoning symptoms. Naloxone can be used to detoxify and treat patients with Observe for at least 48 hours for timely detection of central nervous system inhibition.

▎Montmorillonite Powder:

In acute diarrhea, the initial dose should be doubled and dehydration should be corrected. When constipation occurs, the dose can be reduced and continue to take. For other notes, see “

What are the advantages of montmorillonite powder for diarrhea? This medicine may be in vain.



Loperamide and montmorillonite powder have different mechanisms of action and different clinical applications and cannot replace each other. If there is no infection in diarrhea patients, loperamide can be used; if it is accompanied by infection, montmorillonite powder should be used. Diarrhea with intestinal bacterial infection must be treated with effective antibiotics; dehydration must be corrected in dehydrated patients.

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This article was first published: Digestive Liver Disease Channel in the Medical Community

The author of this article: Ge Jinhua

Review of this article: Yang Health, Deputy Chief Physician, Jingdezhen Second People’s Hospital

Editor in charge: Wen Jiaxin

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