Can I take Imodium and ibuprofen together?

Do Imodium and ibuprofen interact?

Not on paper. The Imodium A-D Drug Facts label contains 1 active ingredient, loperamide 2 mg per caplet, and its only interaction note is that loperamide may interact with certain prescription drugs. It does not name ibuprofen, NSAIDs or pain relievers. The Advil label does not mention loperamide or diarrhea medicines either.

An interaction that is not listed is different from a combination that has been proven safe for you. The Advil label tells you to ask a doctor or pharmacist before use if you are taking any other drug, and the Imodium label says the same if you take a prescription drug. A pharmacist can check your full list.

• Imodium A-D caplets: loperamide 2 mg. No pain reliever.
• Advil: ibuprofen 200 mg, an NSAID. No anti-diarrheal. Motrin is also ibuprofen.

Why can ibuprofen be a problem during a stomach bug?

The issue is less about Imodium and more about the bug itself. Two things make ibuprofen trickier when you have vomiting or diarrhea.

• Your stomach. The NHS lists indigestion, stomach aches, nausea, vomiting and diarrhea as common ibuprofen side effects, and says to take it ideally with or after food. During a stomach bug, that can add to the symptoms you already have. The Advil label says to take it with food or milk if stomach upset occurs.
• Your kidneys. NHS Scotland's sick day rules name NSAIDs such as ibuprofen as medicines that, during an illness that dehydrates you (such as vomiting, diarrhea or fever), may impair kidney function and could lead to kidney failure. If you can't keep fluids down, ask a pharmacist or doctor before taking ibuprofen.
• Bleeding signs can look like a gut problem. Ibuprofen can cause stomach bleeding, and the Advil label lists bloody or black stools and vomiting blood as signs to stop and call a doctor. Imodium's label says not to use it at all if you have bloody or black stool.

How much Imodium is the limit?

For adults and children 12 and over, the Imodium A-D caplet label says to take 2 caplets after the first loose stool, then 1 caplet after each later loose stool, and no more than 4 caplets in 24 hours. The FDA states the maximum approved adult daily dose for over-the-counter use is 8 mg, which is those same 4 caplets.

The label carries a heart alert: taking more than directed can cause serious heart problems or death. The FDA says loperamide is safe at approved doses, but much higher doses can cause severe heart rhythm problems. Most reported cases involved people deliberately taking very high doses, so the point is simple: don't take extra because the diarrhea is bad.

Stop Imodium and ask a doctor if your symptoms get worse, diarrhea lasts more than 2 days, or your belly swells or bulges. Imodium may also cause tiredness, drowsiness or dizziness, so be careful driving or using machinery.

How much ibuprofen can you take?

For Advil 200 mg tablets, adults and children 12 and over take 1 tablet every 4 to 6 hours while symptoms last. If 1 tablet doesn't help, 2 may be used. Don't take more than 6 tablets in 24 hours unless a doctor tells you to, and use the smallest dose that works.

Don't stack NSAIDs. The NHS says not to take ibuprofen at the same time as other NSAIDs such as naproxen (Aleve) or aspirin, and the Advil label says taking other NSAIDs, including other ibuprofen products, raises the chance of severe stomach bleeding. If you take daily aspirin for your heart, the Advil label says to ask a doctor or pharmacist first, because ibuprofen may reduce that benefit.

Who should ask before taking either one?

Check with a doctor or pharmacist before combining them if any of these apply to you.

• Fever, or mucus in your stool: the Imodium label says ask a doctor before use. MedlinePlus adds that your doctor will likely tell you not to take loperamide if you have fever, blood or mucus in the stool, or black stools.
• Heart rhythm problems or liver disease: ask a doctor before Imodium. MedlinePlus lists heart rhythm drugs such as amiodarone, quinidine and sotalol, plus methadone and some antipsychotics, among drugs to discuss with your doctor.
• Kidney disease, a diuretic (water pill), high blood pressure, heart disease, liver cirrhosis, asthma or a past stroke: the Advil label says ask a doctor before use.
• Higher stomach bleeding risk: age 60 or older, past ulcers or bleeding, a blood thinner or steroid, or 3 or more alcoholic drinks a day. The Advil label says ask a doctor first if this applies to you.
• Pregnancy or breastfeeding: both labels say ask a health professional first. The Advil label says not to use ibuprofen at 20 weeks or later in pregnancy unless a doctor directs it, and the NHS says avoid ibuprofen in pregnancy unless a doctor or pharmacist advises it.
• Children: Imodium is not for children under 2, and the label says ask a doctor for ages 2 to 5. Advil tablets say ask a doctor for children under 12.

What matters most while you have a stomach bug?

Fluids. The Imodium label and MedlinePlus both say to drink plenty of clear fluids to replace what you lose with diarrhea. If you keep being sick and can't keep fluids down, the NHS says to get urgent medical advice, and that is also the time to ask before taking ibuprofen.