Loperamide (OTC) should be avoided or used with caution in which population?

• A. Adults over 65
• B. Children under 2 years old and cases of suspected infectious diarrhea or dehydration
• C. Pregnant women
• D. People with inflammatory bowel disease

Answer: (B)

Slowing bowel movement with an OTC antidiarrheal can be risky when diarrhea is caused by an infection or when dehydration is present. Loperamide works by reducing intestinal motility, which helps firm up stools, but it can also keep pathogens, toxins, and fluid in the gut longer. In young children, especially those under two, this is particularly unsafe because they are more vulnerable to rapid fluid and electrolyte loss. Delaying medical evaluation and masking the severity of illness can lead to worsening dehydration or other complications. For suspected infectious diarrhea or dehydration, the priority is rehydration and careful medical guidance rather than self-treatment with loperamide. In other populations, use may be considered with caution, but the scenario posing the greatest risk and thus the strongest reason to avoid or limit use is in children under two with suspected infection or dehydration.