Possible therapeutic use of loperamide for symptoms of lactose intolerance

OBJECTIVES: To examine a potential practical therapeutic use of loperamide (Lo) to decrease the symptoms of lactose intolerance. SUBJECTS AND METHODS: Nineteen (eight men, II women) healthy lactose maldig esters (18 of 19 with symptoms) underwent a 25 g lactose challenge on five separate days. Breath hydrogen was measured, areas under the curve (AUC) we re calculated for 4 h, and 4 and 12 h symptom scores were recorded. After e stablishing baseline measurements, test doses of 4 mg, 8 mg and 12 mg Lo we re 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 resp onse expectations; however, only lactase treatment achieved significance. N evertheless, 8 mg Lo significantly improved symptom scores, which were stat istically 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 m ay have some side effects. However, Lo may be studied further as an adjunct ive treatment of lactose intolerance in an effort to reduce the need for co mplete lactose digestion. Such a manoeuvre may allow rapid colonic adaptati on, which in turn may be beneficial for prophylaxis for a number of colonic diseases.