Diarrhea is a distressing symptom which limits the quality of life in patients receiving
palliative care and is associated with high morbidity and mortality. In patients with
AIDS, it is a more common problem than for other entities (e.g.,
cancer).
Loperamide is considered the first choice medication for the symptomatic treatment of
diarrhea. This literature review examines the efficacy of
loperamide in the symptomatic treatment of
diarrhea in
palliative care. Two databases (Medline and Embase) were searched through June 2012. A total of 286 studies were identified, but only 7 met the inclusion criteria (1 cohort and 6 experimental studies) in which
loperamide (alone or in combination) was tested. There is a lack of significant studies which investigate the efficacy of
loperamide in the symptomatic treatment of
diarrhea. Two trials indicated superiority of
loperamide over placebo. In comparison with
octreotide, the results were contradictory. The combination of
acetorphan with
loperamide was more effective than
acetorphan alone, but the combination of
loperamide with
diphenoxylate was inferior to
octreotide. The identified studies revealed methodical problems. A definite recommendation for administration of
loperamide can, therefore, not be derived from this work.The English full-text version of this article is available at SpringerLink (under "Supplemental").