Loperamide have negative effects from rebound constipation. If a suspicion exists of diarrhea associated with organisms that can penetrate the intestinal walls, such as or "Salmonella", loperamide is contraindicated as a primary treatment. Loperamide treatment is not used in symptomatic "C. difficile" infections, as it increases the risk of toxin retention and precipitation of toxic megacolon. Loperamide should be administered with caution to people with liver failure due to reduced first-pass metabolism. Additionally, caution should be used when treating people with advanced HIV, as cases of both viral and bacterial toxic megacolon have been reported. If abdominal distension is noted, therapy
Loperamide 2-mg tablets was added to WHO Model List of Essential Medicines. It is sold as a generic medication and is not very expensive. The wholesale cost in the developing world is about US$0.004 to 0.040 a dose. In August 2016, the US retail cost is about US$0.31 per dose. In 2016, Imodium was one of the biggest-selling branded over-the-counter medications sold in Great Britain, with sales of £32.7 million. Loperamide was originally marketed as Imodium, and many generic brands are sold. Loperamide has typically been deemed to have a relatively low risk of misuse. In 2012, no reports of loperamide