Possible therapeutic use of loperamide for symptoms of lactose intolerance
A Szilagyi | A Torchinsky | A Colacone
OBJECTIVES: To examine a potential practical
therapeutic use of loperamide (Lo) to decrease the symptoms
of lactose intolerance.
SUBJECTS AND METHODS: Nineteen (eight men,
11 women) healthy lactose maldigesters (18 of 19 with
symptoms) underwent a 25 g lactose challenge on five
separate days. Breath hydrogen was measured, areas under
the curve (AUC) were calculated for 4 h, and 4 and 12 h
symptom scores were recorded. After establishing baseline
measurements, test doses of 4 mg, 8 mg and 12 mg Lo
were randomly administered without placebo in a double-blind
manner. As well, each subject received seven lactase
tablets, in a random, unblinded manner.
RESULTS: The median AUC and mean oral cecal transit
time followed dose response expectations; however, only
lactase treatment achieved significance. Nevertheless,
8 mg Lo significantly improved symptom scores, which
were statistically indistinguishable from those of lactase.
Four subjects complained of delayed constipation and
cramps with various doses of Lo.
CONCLUSIONS: Lo monotherapy for lactose intolerance
is not economical and may have some side effects. However,
Lo may be studied further as an adjunctive treatment
of lactose intolerance in an effort to reduce the need
for complete lactose digestion. Such a manoeuvre may
allow rapid colonic adaptation, which in turn may be
beneficial for prophylaxis for a number of colonic diseases.