Don't leave home without this medicine

Could it have been was something I ate while trying to use up the food in my refrigerator before leaving for my long-awaited vacation to Italy? Did I come down with a 24-hour stomach bug? Whichever it was, I was attacked by diarrhea while driving to the airport!
After several frantic restroom stops and doses of anti-diarrheal medicine from my carry-on bag, I finally got checked in at Sea-Tac airport. With 23 hours of travel between Seattle and my final destination, I was lucky; I was able to replenish my stash of anti-diarrheal pills at one of the airport kiosks. It took several more doses and most of the trip from Seattle to Rome for my stomach to settle. Thankfully, I then could spend my vacation admiring Italian art and scenery instead of sprinting to Italian restrooms.
My go-to remedy for diarrhea is Immodium-AD® (loperamide). First introduced as a prescription medicine in 1976, loperamide has been available over the counter (OTC) for many years and has proven to be a VERY effective medicine for acute diarrhea.
During digestion, your food turns into a liquid mass of nutrients just waiting to be absorbed into your body. The muscles that line the inside of your intestines are designed to work together. They squeeze your food in a coordinated rhythm called peristalsis, moving your food through your intestines, inch by inch.
The coordinated movement of your internal intestinal muscles moves this food mass through your small intestine, large intestine, and then your colon, allowing your body to absorb its nutrients and water along the way. What is leftover is then eliminated as feces. The longer it takes the food to move through your intestine, the more water is absorbed into your body, and the firmer your feces or stool becomes. If the food moves too quickly, your body won't have time to absorb much of the liquid and nutrients, creating diarrhea. If the food mass moves too slowly, too much water can be absorbed, making the stool hard, encouraging constipation.
I experienced constipation for the first time when given cough syrup containing the narcotic codeine to treat my severe from whooping cough. Constipation is a common side effect of pain medicines like codeine, hydrocodone, and oxycodone. These drugs cause the movement of the muscles that line your intestine to slow down. Loperamide is closely related to these powerful painkillers. It relieves diarrhea by slowing down your intestinal muscles like its more powerful cousins, helping ease intestinal cramping and diarrhea.
Loperamide doesn't relieve pain like other opioid medicines. However, some people have discovered that if you take enough loperamide, you can get "high" or stave off the misery of narcotic withdrawal. The Food and Drug Administration has reported cases of people taking 4 times the maximum dose of loperamide experiencing euphoria, confusion, and heart palpitations.
Pepto-Bismol® (bismuth subsalicylate) is another medicine that I always pack when I travel. It reduces abdominal cramping, nausea, and diarrhea but is not quite as effective in relieving diarrhea as loperamide. Available as wintergreen-flavored chewable tablets, liquid as well as regular tablets, Pepto-Bismol® will turn your stools black.
Some people recommend probiotics for diarrhea. I have found them helpful to reduce diarrhea in my dogs, but personally? I find Imodium-AD® MUCH more reliable.
Here Are 4 Tips on Treating Acute Diarrhea:
1. Be prepared.
I always keep Immodium-AD® (loperamide) tablets and some Pepto-Bismol® chewable tablets on hand, both at home and on vacation. I want to meet new people and see new sights, not spend my vacation seeking out or sprinting to the nearest bathroom.
2. If the first dose doesn’t work, add Pepto-Bismol.
You can take Pepto-Bismol (bismuth subsalicylate) in addition to loperamide, even at the same time. I always pack the chewable tablets, but if you hate the taste of wintergreen, buy the non-chewable pills that you swallow instead. Beware: bismuth subsalicylate will turn your stool a dramatic charcoal-black color.
3. Don’t overdose on loperamide.
The maximum dose of 8 tablets of Immodium-AD (loperamide) in 24 hours should be plenty to do the job. Take 2 tablets to start after your first loose stool and one tablet after each loose stool after that. You can also take both loperamide and Pepto-Bismol® (bismuth subsalicylate) together at the same time.
4. Seek medical attention.
Some types of diarrhea will need immediate medical attention instead of just an anti-diarrheal medicine. If you experience bloody diarrhea, vomiting, and diarrhea for more than 24 hours, have severe abdominal pain with diarrhea, seek medical attention right away.

Dr. Louise Achey, Doctor of Pharmacy, is a 40-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog TheMedicationInsider.com.® 2021 Louise Achey