Lomotil is a good alternative to loperamide. It’s by prescription and is a controlled substance, but it will be dispensed in whatever quantity your doctor orders. It’s pretty cheap, maybe cheaper than loperamide.

Thanks for quick reply, Scott!

Atropine is added to Lomotil to discourage abuse. Most people can tolerate two tablets of Lomotil (as a strong dose) just fine, but some may find one tablet their limit due to the atropine side effects.

FWIW, bowel slowers like loperamide and Lomotil just delay the inevitable, though they might allow for more water absorption or a more reasonable transit time. I take Lomotil at bedtime or when I’m going to be in a bathroom-free zone for a while, but otherwise I don’t find a lot of benefit. If you’re going too frequently it has more to do with your pouch capacity than anything else. Pouch capacity isn’t simply the size of the pouch, but the volume at which you feel it’s necessary to use the toilet. When my pouchitis is untreated, for example, my pouch capacity is miserably small.

Scott F posted:

FWIW, bowel slowers like loperamide and Lomotil just delay the inevitable, though they might allow for more water absorption or a more reasonable transit time. I take Lomotil at bedtime or when I’m going to be in a bathroom-free zone for a while, but otherwise I don’t find a lot of benefit. If you’re going too frequently it has more to do with your pouch capacity than anything else. Pouch capacity isn’t simply the size of the pouch, but the volume at which you feel it’s necessary to use the toilet. When my pouchitis is untreated, for example, my pouch capacity is miserably small.

I agree with everything posted by Scott F. above.  I found that my frequency related more to untreated inflammation and that lomotil/loperamide had the effect of overthickening stools and exacerbating inflammation.  Proper treatment slows down frequency.  I use loperamide exactly as Scott F does - when I will be in a bathroom free zone for a prolonged period or at bedtime, or on occasion when I have normal course diarrhea related to something I have eaten that causes watery stool.  I usually only need 1 pill - in isolated instances -most often I take none, and when needed I never take more than 2 or 3 in a day.  I do take levsin at bedtime to control nightime motility, and I think many patients often confuse a motility issue with frequency that needs to be treated with antidiarrheals.  The distinguishing factor is large amounts of BMs after eating meals = MOTILITY ISSUE.

When I read about the daily volume of loperamide being consumed by some posters here I become very concerned because I frankly do not think it's healthy and they may be unwittingly becoming "druggies" as TCM said (when I drink a large amount of alcohol it slows me down as well- but becoming an alcoholic is not a solution to the issue either). I also think in the past I read a number of posts where I suspected that either loperamide or "tincture of opium" were being thrown at frequency issues in lieu of proper treatment, to the severe overall detriment of the user's health.  These are central nervous system depressants, drugs which should be used very sparingly IMHO, and for the reasons suggested by Scott and NOT as treatment of a consistent frequency issue.

Back when I got my J Pouch I was told it expands and gains capacity over the course of time and I was encouraged to hold it in as long as possible in order to assist the natural expansion process.  For those who are experiencing frequency right after takedown and attempting to fight this process by using large amounts of bowel slowers, they are delaying or thwarting the ability of the J Pouch to expand naturally over the course of time so that it will have a large "cargo capacity" which, in the long term, will decrease frequency.  Bowel slowers taken in large quantities certainly do not assist this expansion process.

Thanks for your reply and the good info.  When I had my total colectomy and bag in July 08, followed by the j-pouch several months later July 2008, my surgeon advised using Loperamide.  I don't know how unique my situation is but I have little rectum left due to the cancer,  and hardly any muscular control there as a result.  So it has been a challenge from day 1.   This includes some potential alternatives that did not help, including an expensive FENIX magnetic system designed to open and close the sphincter.   So I have continued the Loperamide at about 2 caplets every 3 - 4 hours.  That pushes up against the maximum recommended doses.  I tried Lomotil and it didn't make a difference.   However, I didn't try it independent of the Loperamide so I may pursue another shot at it.  I do think it's easy and pretty normal (for me too) to forget that although we all look pretty much the same, our systems can be unique so some things work for some people and not for others.    Various of my doctors have said that many times.  (For example, alcohol does not have same positive outcome for me, although I do like my martinis.)   I have given a lot of thought to your and Scott's  comments and will send copies to my surgeon for her reaction. Also, today I started to extend the time intervals of the Loperamide to see if that makes any difference, good or bad.  I have gone from  4-hour to 5-hour intervals and will gradually increase it in 1-hour increments over the next few days.     Also, I am not familiar with Levsin and will look into it.   

Thank you both.  I really appreciate your thoughtful input.

I totally agree with both comments.  I realized myself that I have to try to hold longer so the pouch will expand.  I also know that Ioperamide is ok but not the answer and take when needed.  I use to take that much in the beginning and that was 5 yrs ago.  I now only take 2 a day or less depending.  I do get my script thru express scripts thru my dr.  My dr ordered 1 cap 3x a day.  Quantity 270 for a 3 mo supply.  

I only use lomitil when I have had watery stools that start burning my skin for several days. So it’s only for emergency purposes for me. But the amount I have to take to start absorbing water and break the cycle is 5. And that much atropine sucks. But by that point, I have so much skin damage and butt  burn that I’m willing to deal with the efffects. I wish I could take this medicine I need without the atropine because it is so counterproductive. But  the drug companies are doing what they are doing to protect us from drug addicts not doing what is right for the sick people. I usually only take these maybe 4 or 5 times all year, unfortunately mostly when I travel. Nervousness from travel is what usually triggers the event. So clearly not a drug addict. Ok, done complaining about reality, again. 😁

I recently got from ebay and Walmart.  I think it was Walmart's brand but sold through ebay.  hat is bad news about Cosco brand.   

I just went to Costco yesterday for loperamide and got the box of 36 for 1.29.  I spoke with the woman at the counter and she suggested that if you can get your doctor to write a prescription for you, you should be able to get more.  Otherwise you're limited to one box a month.  I only take two in the evenings and had some from a bottle that I bought previously.  I meant to ask if this is one box per household but forgot to ask.  If not, I will have my husband get one for me as well.  We'll see if that works.  If not, I could enlist my in laws as well.  

I got a Lomotil prescription from my doctor and have been using it for one month.  I take 1 every 6 hours  and increase it to 2 at bed time, so 5 per day.  It seems to be a little more effective than Loperamide for me but it costs me about $30 per month after insurance compared to the dirt cheap Loperamide.  I don't recall if the Costco rule is per person or per household.  Good luck to you.

Thanks for the information. I have been buying the COSCO stocked brand Kirkland on-line on ebay. I order 2 of the 200 sized bottles. The price seems to be higher each time I purchase them. I use 5 a day and am stocked up for months. There are expiration dates to factor in.

I just checked Amazon.  I believe it was about 90.00 for a 200 ct. bottle that used to sell for about 2.75 at Costco before all this craziness!

Agree.  I stocked up before getting the Lomotil prescription.  The price was sky high.  I think someone is gouging us.  I may have to get out our antique voodoo doll and insert a few needles with that person in mind.      

I'm glad I have 6 or 7 bottles of the 200.  If it goes much higher I will go back to using the prescription loperamide.  My insurance quit covering it and I think it was going to cost me around $120 for 270.  The prescription is better for me as it's a capsule vs the little green pill.

You would think that cost should factor into insurance coverage. I'm pretty sure once they stop covering something it doesn't start back up.  But.... if it was reclassified it as an opioid, since that is why they are limiting it, then maybe insurance would cover it. It's ridiculous that we have to pay so much for it when we know how cheap it is to make.