Squish/Simke: How many mg/kg Imodium for dog?

[BuddyRoo]

I’ve seen various dosages mentioned online.

When I was giving the kaopectate, it would give us a “plug” in front of the liquid stool. I was giving 20ml of the liquid (don’t have the bottle in front of me).

I couldn’t find liquid Imodium that was not mint flavored and wasn’t sure how that would pan out so I got the caplets.

Each tab contains: 2mg Loperamide HCL and 125mg Simethicone.

He had 20ml of kaopectate yesterday a.m., had the “normal” plug plus liquid.

Gave 2 tabs of the Imodium last night based on the doseages I was seeing and he had liquid explosive stools overnight at some point.

I left a message for my vet yesterday and called again this a.m. but thought I would ask you guys in the meantime.

He weighs approx 85 lbs, 33kg.

[SquishTheBunny]

Sorry Buddy, Im not sure We dont normally suggest Immodium (although Im sure there isnt harm in trying!).

Our diarrhea go to’s are metronidazole, tylosin (which you have both tried), and injectale dipyrone (which I dont believe is available in the states). Probiotics, some sort of biosponge etc. also are recommended for the chronic diarrhea type. Most of the time though, after exhausting all these drugs it is the steroids that do the trick.

I’d certainly give the immodium a shot though, just have no idea of the standard dosing. Sorry!

[BuddyRoo]

No worries. Thanks for checking in. I will give the online recc dose, doubt it can hurt anything. But it sure doesn’t seem to be working as well as the kaopectate did.

I ordered the Endosorb and more Fortiflora. It will be here on Monday.

I couldn’t do the ACTH this week, so will have to put off til next week and cross fingers that I can get in. I’ve called the clinic a couple of times in the last few days, no call back. So I don’t have an appt yet.

Thanks again!

[trubandloki]

Did you try pumpkin?

[BuddyRoo]

Oh yes.

Pumpkin. Tylin. Metronidazole. Rice. Probiotics. Yogurt.

Kaopectate has given us the “plug” enough to get through the night. Switched on recommendation here to Imodium last night. Was not good.

He’s on a food trial of Z/D and has been for 2 weeks. No change.

I’m just trying to buy time, not find a cure at this point. And by “buy time” I mean time between needing to go outside with liquid stool. Even if I get up every 2 hours overnight, it’s not always enough. Once he gets the urge, there’s very little he can do to hold it.

We’d done pretty well for about a week on the kaopectate though. Took him off of it for a day and boom. More messes in the house.

[trubandloki]

Poor dog. Poor owner! Both of you must be miserable.

[BuddyRoo]

Actually, he’s doing really well. This has been going on for almost 4 mos now. He’s had major surgery (redid the anastamosis from last year), he had been down about 25 lbs at the worst of it but is putting weight back on. He is energetic, happy, eating well, in good spirits. It’s just this interminable liquid stool problem! And we’ve done every test possible including biopsy of the intestine and nothing stands out. I have great vets at MSU who continue to follow up via phone since we’ve now moved to VA.

I, on the other hand, am getting frustrated. Most days of the last 4 mos have begun with me finding piles of liquid feces in the house IF I don’t set an alarm and get up in the middle of the night several times. I also can’t be gone for more than a couple of hours during the day which means I don’t get to see my horse much as she’s an hour away. I’m not going home for Xmas due to this (but I’m not heartbroken so no worries.). I am a regular Rug Doctor renter now. (white carpet in rental…awesomeness!)

I’m told we need to give this food trial 4-6 weeks, all I want to do is not have to clean up liquid crap every day for ever and ever.

The last test on our list is for Addison’s which no one really thinks is the problem. But we want to do that before just putting him on steroids. He may well have IBD…but nothing has pointed at that definitively.

So…

Anyway. We’re fine-ish. I mean, it could be a lot worse!

[Simkie]

BuddyRoo, I give my 70 lb dogs one tab up to twice daily. I always withhold food for two meals in the beginning.

It looks like I might be on the low side for dosage according to this, so you could go higher: http://www.vetinfo.com/dog-diarrhea-treatment-with-loperamide.html

If the koapectate works and gives you some time, you could also continue that. It’s just clay and pectin, right? Shouldn’t cause any problems long term

[BuddyRoo]

Simkie, I gave him two last night. But what I’m reading says not to go past a few doses. He is fasted since last night at this point though. Maybe since it’s the tablet and not the liquid though, it takes longer to kick in whereas giving a liquid like the Kao does more immediate effects? I dunno.

As for the kaopectate, it’s Bismuth Subsalicylate (262mg).

At this point, I’m kind of in the try anything state of mind.

I am going to be completely home bound until next Wed as hubby will have the car out of state, so whatever I need to stock up on, I need to get today. I’m just trying to decide what to get!

[Simkie]

If it’s going to work, I’d say you’d see an effect in 3-4 BID doses. I have never had to give it more than that, but I have also never dealt with what you’re going through.

Were I in your shoes: if the koapectate helps, then I’d continue that and continue with the Imodium for a couple days to see if you can get some firming up. I’d also try one of the pectin anti-diarrheals, just for giggles. Sure won’t hurt. I may also give some psyllium a trial: http://www.umm.edu/altmed/articles/psyllium-000321.htm

Good luck!

[Simkie]

Here’s an actual published study showing that psyllium slows things down in the gut and is effective at treating diarrhea:

http://ajcn.nutrition.org/content/67/2/317.full.pdf

Worth a shot!

[BuddyRoo]

Thank you.

[LauraKY]

OP, I can’t remember what breed your dog is, but if he has the MDR1 gene, Imodium is a huge no no.

Collies, Aussies, Shelties, sight hounds…

http://www.vetmed.wsu.edu/depts-vcpl/breeds.aspx

[wendy]

well, hey, maybe this little experiment might give us some insight into what is wrong with your dog-
kaopectate, which is helping the dog, works by:
It reduces symptoms of diarrhea by slowing intestinal secretions, which decreases fluid loss in diarrhea patients.
It may inhibit the synthesis of prostaglandins which are responsible for intestinal contractions and inflammation.
It may have an antimicrobial effect against numerous diarrheal pathogens. It binds with the toxins produced by the bacteria.

while immodium acts on the nerves/smooth muscles of the intestine to slow down contractions of the gut, so the contents move more slowly along and thus water can be re-absorbed from the stool in the colon and the frequency of diarrhea episodes goes way down.

so let’s speculate, maybe your dog is secreting large volumes of fluids abnormally into the intestine? so kaopectate, which would inhibit this, would work, while simply slowing the intestine down via immodium, wouldn’t.

kaopectate tends to be more effective against diarrhea caused by bacterial infections, which stimulate intestinal fluid secretion, than it is against diarrheas caused by things like irritable bowel, which is mostly a disease of abnormal intestinal contractions (immodium is very effective for irritable bowel diarrhea).

[BuddyRoo]

Thanks Laura. He’s a lab…purebred (hell of a lot of good THAT does sometimes, eh? LOL)

He seems fine w/ it…but he only had the one dose. No bad symptoms, just not the results I had hoped for.

[Simkie]

Interesting, LauraKY, I’d not heard that. BRoo’s got a Lab, IIRC.

Wonder how the gene got into the Whippet. Other sighthounds are not effected (other than the Silken Windhound, which was created using the Whippet.) Curious.

[BuddyRoo]

wendy, holy cow.

God. Thanks for putting all that together.

So…were it you…based on the following.

1. we are currently treating as if this is an allergy. Which would created inflammation.

2. We’ve done fecal smear, fecal, panacur just in case, and metronidazole. None of which showed any signs of issues nor helped.

So do you think it follows that it’s an allergic reaction? Still unresolved? Or do you think bacteria?

The vets are crickets right now so I’m taking what I can get and you guys have been along for the whole ride so I appreciate the input.

[Simkie]

BuddyRoo, also consider that you might need more than one dose of Imodium to be effective. I wouldn’t write it off until you have 3 - 4 doses in the dog. Be sure to give it a fair trail before crossing it off your list

Wendy’s observations do lead one to think some psyllium could be effective, though, based on that study!

Just out of curiosity, does your dog have a high eosinophil count?

[BuddyRoo]

Simkie, no, his last cvc/chem panel really showed nothing out of range. His granulocytes were a little on the higher end of normal, but still within normal ranges.

And his maldigestion profile from TX A&M showed nothing abnormal.

This is why I feel so mind…effed. For lack of a better word! It’s not like we’re not testing every bloody thing possible.

I’m sorry to keep posting about this, but it’s just driving me batty. THere has to be a diagnosis and a treatment, right? I’m not terribly impressed with the vet I chose here…she just goes dark for periods of time and it’s very frustrating. I would LIKE to be discussing this with a veterinarian. I find it kind of sad that I’m getting calls and texts from MSU and my vet back home–who have nothing to gain–but total crickets here. GAH.

[wendy]

I found this about the mechanism of diarrhea due to allergies:

“Harmful irritants reaching the small intestine can initiate what is called a peristaltic rush, which can empty the entire small intestine into the colon within a few minutes. Food you are allergic to can also do this and lead to diarrhea due to the lack of time for fluid absorption.”

that would manifest as an “explosive fluid” diarrhea, I would suspect. Since it’s a “contraction of the gut” problem then you’d expect that diarrhea caused by allergies would respond to immodium.

However, when they treat chronic diarrhea in people due to inflammatory diseases they follow this dosage protocol. Your dog is about half the size of an adult human, so half the dose I would guess. It sounds like you might need to keep dosing repeatedly at first until you get the gut contractions to slow down sufficiently to control the diarrhea- they didn’t give up on the immodium until after ten days of treatment, see the text below.

"Adults: The recommended initial dose is 4 mg (two capsules) followed by 2 mg (one capsule) after each unformed stool until diarrhea is controlled, after which the dosage of IMODIUM® should be reduced to meet individual requirements. When the optimal daily dosage has been established, this amount may then be administered as a single dose or in divided doses.

The average daily maintenance dosage in clinical trials was 4 to 8 mg (two to four capsules). A dosage of 16 mg (eight capsules) was rarely exceeded. If clinical improvement is not observed after treatment with 16 mg per day for at least 10 days, symptoms are unlikely to be controlled by further administration. IMODIUM® administration may be continued if diarrhea cannot be adequately controlled with diet or specific treatment. "