Hello,

I take 3 Imodium per day; breakfast, dinner, bedtime.  I have not found any decrease in efficacy since my takedown in May of 2021. My body has adapted nicely to the therapy and I no longer feel constipated from it lIke I did in the beginning.

I find that it prevents loose burning stool and tends to keep my BM’s btw 6 and 8 per day.

if I could  take less I would, but I have been told by my GI and surgeon it is safe for long term use.

would it reduce your 6 BMs a day? ( btw , that is a very good number)

only you could answer that.

but my personal opinion is that I would like to take the least medicine possible.  So if I can reduce I will, but if I need a medicine for this or any of my medical conditions, I am going to take it.

that's been my personal opinion too - to not take medication unless I need it.

actually, I think i'm at about 8BMs a day and immodium would reduce to 6.

I actually just did a good bit of googling on this. The dependency aspect of it comes from meth users who use large quantities of imodium to get off their meth dependency (like 50/day...I mean *large*). As you can imagine, constipation then becomes a big problem for them. But this is the scenario that pharma is worried about...they are trying to get imodium packaged into bubble packs instead of bottles to deter this consumption...which I noticed recently and found it pretty annoying, but now I understand why they are doing it.

Everyone has their own balance of medication vs QOL. In this respect, you can play with imodium to see what works for you. If taking two imodium keeps you from going to the bathroom four times at a dinner party, then maybe you only take two an hour before you go to a dinner party. The nurse yesterday told me that the half life of imodium is 10 hours, and max effectiveness is 3 hours in.

So, you can use it as a tool in your toolbox, as it is generally safe at the doses we're looking at (max 8 2mg caplets per day). I was taking 5 daily before my takedown, and now I'm taking 8 daily. I just have a really eager intestine, I guess. But be conservative, cuz you definitely don't want to go too far the other direction, esp if you're prone to that. Your doc or GI nurse probably has some good advice for your specific situation. 

When you say that it's generally safe at 8 per day, where does this number come from?

When you say 8 a day is "safe", you mean for dependency purposes, and not fecal impaction purposes, correct?

Oh, that's correct, CT. 8 imodium/day is like the threshold that the gi doctors give for "don't go above this limit." (Adult limit from my gi docs and several places that I have read online). For fecal impaction, everyone is different. So you want to start small and make sure you can tolerate each additional pill for a few days before moving up (and only move up if you have to). You don't want to get impacted. My statement about using 8 was just to say: "I'm someone who is using 8/day because I need to. And my doctors feel this is safe for me, no side effects, no organ damage, etc. So do not be afraid of using that much imodium *if you and your doctor decide that's what's needed for you*." I suspect this dosage will be too much for most people.

I was very afraid to take more than 4 imodium/day early on, and I waited way too long and went through a lot of anxiety and pain about taking more. Even though that's what was needed. Even this week, after I used to take 5/day for 4 months with my loop ileostomy, I didn't want to take 8/day for fear of taking too much and getting impacted post-takedown. I now regret that anxiety because it cost me pain and too many of those "I'm not sure I'm cut out for a jpouch" episodes of exasperation.

So I'm just trying to convey that, if you need more imodium than the max 4 that the bottle tells you, you're in good company. And it's not like taking more than, say, aceteminophen, that could cause kidney damage, etc. Proceed conservatively, but if you have a very active intestine, don't be afraid to use the tools available to you instead of suffering. I hope I'm conveying my message correctly.

To clarify, I’m talking about only taking 1 per day. So, going from 0 a day to 1.

Unfortunately, I haven’t been able to find a knowledgeable GI under my insurance plan. The ones I’ve seen under this plan had never had a patient with a j pouch before so I don’t trust any of their advice.