Is Loperamide (Imodium) the Best Medicine to Relieve Diarrhea?

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I think most people agree that loperamide (Imodium) might be one of the best anti-diarrhea medicines.  A study published in the July 28, 2004 issue of the Clinical Therapeutics, however, suggested that an ancient Japanese herbal medicine, Seirogan, was as good as Imodium in stopping diarrhea. 

Seirogan is a Japanese medicine that has been marketed in Asia for the past century as an antidiarrheal and antispasmodic medication.  It main ingredient is wood creosote and has been used for medicinal purposes in Europe since the early 1800s. 

Wood creosote has been shown to inhibit the peristaltic contraction of intestinal smooth muscle and to promote net fluid absorption or decrease fluid secretion in the intestine in in vivo and ex vivo animal models and in in vitro experiments. 

The study reported in the Clinical Therapeutics was a randomized, double-blind study that involved 123 patients with acute, nonspecific diarrhea at 12 centers across the United States and Mexico.  All patients had diarrhea in the past 3 days and also had nausea, vomiting, abdominal cramping or fever.  

Patients were randomized to receive either wood creosote 135 mg or loperamide 4 mg, followed by 2mg after each lose stool for 3 days or less.  

At the end of the study, there was no difference between the 2 treatment groups in the time it took to resolve the diarrhea (24.4 hr in the wood creosote group vs. 22.1 hr in the loperamide group). 

However, more patients in the wood creosote group (92.5%) than in the loperamide group (78.0%) experienced an improved or resolved abdominal cramping at the end of day 1. (P<0038)  

The investigators concluded that wood creosote and loperamide had comparable antidiarrheal effects in patients with acute and nonspecific diarrhea. However, wood creosote appeared somewhat more efficacious in improving or resolving abdominal cramping, whereas loperamide appeared somewhat more efficacious in improving diarrhea.   Both products are well tolerated.

It is important to note that the Seirogan tablet formulation that is marketed in Asia contains wood creosote plus other herbal ingredients, including gambir, philodendron bark, glycyrrhiza, and citrus unshiu peel.  The other herbal ingredients are thought to ameliorate any gastrointestinal adverse effects (AEs) attributable to wood creosote. 

Next time, when you have an acute diarrhea and do not want to use Imodium, you might like to consider Seirogan

Source: Clinical Therapeutics 2004;26:1644-1651.

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