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Calm the chaos of diarrhoeaSupporting customers to take control of their symptoms
8-minute module
Diarrhoea is one of the most common symptoms that people seek medical advice for.1 You have an important role in providing useful advice to customers to support its management and prevention.
Learning objectives
Be able to recognise potential triggers for diarrhoea
Be able to make suitable recommendations to customers, particularly those interested in pre-symptom purchases when planning a trip abroad
Understand how the new Gut2Know™ by IMODIUM® app may help diarrhoea sufferers understand and manage their holistic gut health
Causes of diarrhoea1-4
There are many potential causes of diarrhoea. Click through the slider to discover some of the most common ones.
Travelling to a foreign country may be a key trigger for diarrhoea.
You can help your customer assess their risk of developing travellers’ diarrhoea and offer appropriate advice to help avoid infection.
Travellers’ diarrhoea is most commonly caused by infection through contaminated food and drinks due to reduced sanitation and hygiene measures in a foreign country. It is associated with at least one additional symptom, such as stomach pain or cramps, nausea or vomiting.5
NICE recommends that diarrhoea that occurs after foreign travel should be investigated.1
Advising customers planning to travel
You can share some preventative measures with your customer to help reduce the risk of getting travellers’ diarrhoea.
Here are some examples:5,6
Wash hands with soap and water and dry them thoroughly before handling food and after using the toilet
Carry antibacterial hand gel in case soap and water are not available
Avoid drinking tap water, ice made with tap water or using it for cooking and brushing teeth. Instead choose bottled water or drinks in factory-sealed containers
Avoid uncooked meat, poultry or seafood, shellfish, and food that contains raw or uncooked eggs, e.g. mayonnaise
Avoid salads and uncooked vegetables if hygiene and sanitation are likely to be inadequate
Try to avoid swallowing water when swimming
Mini quiz
Which of these could you recommend to your customer to be prepared in case diarrhoea develops while they are away?
Make your selection then click 'Confirm choice' to reveal the answer
Oral rehydration salts
IMODIUM®
(loperamide 2mg) tablets
That is correct! However, you could also recommend that they pack some IMODIUM® tablets, which will bring relief if acute diarrhoea occurs without an accompanying fever.
That is correct! Imodium® would be suitable if acute diarrhoea occurs without an accompanying fever. They could also consider taking sachets of oral rehydration salts with them.
That is correct! Your customer may want to consider taking sachets of oral rehydration salts and some IMODIUM® tablets which will bring relief if acute diarrhoea occurs without an accompanying fever.
The impact of diarrhoea extends beyond its physical symptoms. Travellers’ diarrhoea can ruin a person's holiday, but even when at home or at work, diarrhoea can impact their daily life. Due to its unpredictability and urgency,3 diarrhoea can limit what your customers do, where they can go and what they can eat. This may negatively impact their quality of life1 and lead to embarrassment or isolation. Customers who regularly suffer from diarrhoea have been found to have higher levels of depression and anxiety than the general population.7
Advising on diarrhoea in the pharmacy
Considering the impact that diarrhoea can have on your customer’s life, you can play an important role in helping them understand what may trigger their diarrhoea. This will enable them to prepare for key moments and may help them feel more in control. At certain times, your customer may be more exposed to triggers, e.g. when over-indulging during holidays, over the festive season or at celebrations.
You can discuss ways to minimise or avoid some of these triggers with customers. If that is not possible, they may wish to keep IMODIUM® at hand in case they need it.
Some customers may feel embarrassed about having diarrhoea, but you can provide some reassurance by informing them that it is quite common, and you are there to help. Build trust by sharing your expertise, including tips and advice for symptom relief. Be sensitive and empathetic and if they seem reluctant to discuss their symptoms over the counter, offer the consultation room for a more private conversation.
Many people delay seeking advice and treatment for digestive problems due to associated stigmas. Help them feel at ease and encourage them to open up so that you can work together to find the best way forward for them. Helping them understand the possible causes of their diarrhoea may enable them to access timely advice and treatment if needed.
A tool to manage gut health
You can advise your customer to keep a food diary to help them identify possible triggers. The Gut2Know™ by IMODIUM® app can help them do this†, as well as help them track their symptoms, learn about gut health and set health goals.
†The Gut2Know™ app is not a substitute for professional medical advice. If customers experience severe, recurrent or persistent diarrhoea or have any medical conditions they should consult a doctor for further guidance.
Treating diarrhoea with IMODIUM®
IMODIUM® (loperamide hydrochloride 2mg) has been delivering effective diarrhoea relief for over 50 years.*
It can help to treat acute diarrhoea by bringing relief within 1 hour.8
*IMODIUM® was first licensed as an OTC medicine in Belgium in 1973.
Key facts about IMODIUM®
Britain’s most trusted diarrhoea relief brand* and the No.1 best-selling diarrhoea relief brand†
85% of patients prefer IMODIUM® over other diarrhoea relief brands‡
Patients recover from diarrhoea up to 3x faster with IMODIUM®§
96% of patients recommend IMODIUM® for fast relief within 1 hour¶
For verification of these claims, please call 0808 238 9999 †NielsenIQ data. Value, Units, anti-diarrhoea category (client defined) 52 w/e 25.05.2024 (GB total coverage) ‡July 2022 survey of 156 frequent diarrhoea sufferers §Median time to last unformed stool vs placebo ¶July 2022 survey of 304 frequent & occasional diarrhoea suffers
(Also available in 6 or 12-tablet packs as Imodium Instants, GSL)
Mint flavour
Dissolves instantly on the tongue, with no need for water
Contains:
Loperamide to gently slow down movement within the digestive tract and help the body to absorb more water and salts from the bowel
Dose:
8For acute diarrhoea in those aged 12 years and over OR acute diarrhoea associated with diagnosed IBS in those aged 18 years and over:
2 tablets initially followed by 1 tablet after every loose stool
MAX 6 tablets per day
Who can you recommend it to?
Customers looking for on-the-go relief or those who don’t like swallowing tablets or capsules
(Also available in a 6-tablet pack as GSL)
Vanilla flavour
Unique dual formulation tablet
Contains:
Loperamide to relieve diarrhoea
ANDSimeticone to soothe painful cramping, uncomfortable bloating and wind
Dose:
9For acute diarrhoea associated with cramping, bloating or wind in those aged 12 years and over
1 tablet (12-18 years) or 2 tablets (18 years and over) initially followed by 1 tablet after every loose stool
MAX 4 tablets per day
Who can you recommend it to?
Those who suffer with abdominal discomfort along with diarrhoea. As many as 62% of diarrhoea occasions in the UK10 are associated with at least one of these additional symptoms
Please note:
Loperamide should only be used for 48 hours. If diarrhoea lasts for longer than 48 hours with treatment, consultation with a doctor is required
Over the counter treatment is not suitable for everyone. Always check that the product is appropriate for your customer, e.g. by asking WWHAM questions
For more detailed information please refer to the SPC
Self-care strategies
Diarrhoea, including travellers’ diarrhoea, usually resolves in a few days. It is important to prevent dehydration by drinking lots of fluid (regular small sips) or using oral rehydration salts.2,11 Unless there are signs that indicate referral (red flags), your customer can normally manage diarrhoea themselves with rest and adequate fluids. They should eat when they are able to, but avoid fatty or spicy food.2
Red flags1,2,5,6,11
Customers should seek medical advice in certain situations, including:
If diarrhoea lasts more than 7 days
If they have a fever
Diarrhoea is particularly frequent or severe, e.g. passing a large amount of very watery diarrhoea
If they have bloody diarrhoea or bleeding from the bottom
Vomiting and not able to retain oral fluids
They have a weakened immune system, are elderly or prone to complications
They are pregnant with travellers’ diarrhoea
They have Crohn’s disease or ulcerative colitis
Customer scenarios
Choose a customer below to reveal their scenario.
Making a suitable recommendation for Dina
A customer in her mid 30s approaches the pharmacy counter with a packet of IMODIUM® Instants in her hand.
She looks uncomfortable and is holding her stomach.
What could you say to her that might open a dialogue so that you can provide great customer care?
Think about which approach might feel most natural to you.
I can see that you are not feeling your best today. Do you mind if I ask you a couple of quick questions to ensure you get the right treatment?
These tablets will help with symptoms of diarrhoea, but I could make an alternative recommendation if you suffer from other uncomfortable symptoms too.
Before Dina leaves the counter, what other information could you share with her?
You can consider:
Self-care advice
Red flags to look out for
Information about triggers for diarrhoea
Advising her to download the Gut2Know™ by IMODIUM® app
Or you may want to ask whether she suffers from IBS or has recently travelled abroad.
Providing advice to Oscar
A 19-year old male hands you a basket with typical first aid products and asks for painkillers at the pharmacy counter. He excitedly tells you about his upcoming backpacking trip to Asia.
Think about how you could advise him to prepare for his trip.
There is a risk of getting travellers’ diarrhoea when visiting foreign countries. Would you like to talk through some recommendations on how to manage diarrhoea whilst you are away?
If you do get diarrhoea, remember that an important part of treatment is to prevent dehydration. I would recommend that you take some oral rehydration sachets with you in case you need it.
You could take some IMODIUM® with you on your trip. That way you will be able to treat travellers' diarrhoea while you are away. IMODIUM® Instant Melts are useful because you can take it without water and it could be especially useful when toilet facilities are limited or unavailable. If you also develop a fever or other concerning symptoms, do not use IMODIUM®, but seek medical advice instead.
Think about other advice you could share with Oscar, e.g. tips to limit the risk of travellers’ diarrhoea, when to seek medical advice while he is abroad, red flags to look out for, or perhaps your pharmacy offers a travel clinic that you could refer him to.
Bust the myths surrounding diarrhoea treatment so you can help customers recover more quickly
1. NICE. CKS. Diarrhoea – adult’s assessment. 2023. Available at: https://cks.nice.org.uk/topics/diarrhoea-adults-assessment/
2. NHS. Diarrhoea and vomiting. 2023. Available at: https://www.nhs.uk/conditions/diarrhoea-and-vomiting/
3. Harvard Health Publishing. Is something in your diet causing diarrhea? 2023.
Available at: https://www.health.harvard.edu/diseases-and-conditions/is-something-in-your-diet-causing-diarrhea
4. Raypole C. Why anxiety causes diarrhea and how to handle it. 2023. Available at: https://www.healthline.com/health/anxiety-diarrhea#cause
5. NICE. CKS. Diarrhoea – prevention and advice for travellers. 2023. Available at: https://cks.nice.org.uk/topics/diarrhoea-prevention-advice-for-travellers/
6. Hazell T. Traveller’s diarrhoea. 2023. Available at: https://patient.info/travel-and-vaccinations/travellers-diarrhoea-leaflet
7. Lee C, et al. The increased level of depression and anxiety in irritable bowel syndrome patients compared with healthy controls: systematic review and meta-analysis.
J Neurogastroenterol Motil. 2017; 23(3). doi.org/10.5056/jnm16220.
8. Imodium Instant Melts (P). SmPC. 2024. Available at: https://www.medicines.org.uk/emc/product/368
9. Imodium Dual Action Relief Tablets (P). SmPC. 2023. Available at: https://www.medicines.org.uk/emc/product/370
10. J&J Digestive Health U&A Study. 2021.
11. NHS Scotland. Diarrhoea. 2023. Available at: https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/diarrhoea/
Online sources last accessed June 2024
IMODIUM® Instant Melts (loperamide)
Presentation: White/off-white, circular, orodispersible tablet containing loperamide hydrochloride 2mg. Excipients with known effect: each tablet contains 0.750 micrograms of Aspartame (E951) which is equivalent to 0.055 mg/mg and it contains less than 0.00066mg of benzyl alcohol. The Mint flavouring contains traces of Sulphites. Indications: For the symptomatic treatment of acute diarrhoea and acute episodes of diarrhoea associated with Irritable Bowel Syndrome diagnosed by a doctor. Dosage and Administration: Acute Diarrhoea: Adults and children over 12 years old: 2 tablets initially followed by 1 tablet after every loose stool. Total daily dose should not exceed 6 tablets. Symptomatic treatment of acute episodes of diarrhoea associated with Irritable Bowel Syndrome in adults: 2 tablets initially followed by 1 tablet after every loose stool, or as previously medically advised. Total daily dose should not exceed 6 tablets. Method of administration: Allow the tablet to disintegrate on the tongue and swallow; no liquid is needed. Contraindications: Hypersensitivity to loperamide or any excipient. Children under 12 years of age. Acute dysentery, characterised by blood in stools and high fever. Acute ulcerative colitis. Bacterial enterocolitis caused by invasive organisms. Pseudomembranous colitis associated with broad spectrum antibiotics. Conditions when inhibition of peristalsis is to be avoided due to the possible risk of ileus, megacolon or toxic megacolon. Discontinue promptly when ileus, constipation or abdominal distension develop. Precautions: Treatment with IMODIUM® Instant Melts is symptomatic; give specific treatment when appropriate. The priority in acute diarrhoea is the prevention or reversal of fluid and electrolyte depletion, particularly in young children and in frail and elderly patients. Use of IMODIUM® Instant Melts does not preclude the administration of appropriate fluid and electrolyte replacement therapy. Since persistent diarrhoea can be an indicator of potentially more serious conditions, IMODIUM® Instant Melts should not be used for prolonged periods until the underlying cause of the diarrhoea has been investigated. If symptoms persist for more than 48 hours, consult a doctor. Patients with AIDS should stop therapy with Imodium Instant Melts if abdominal distension develops. Contains maltodextrin which contains glucose, patients with rare glucose-galactose malabsorption should not take this medicine. Contains benzyl alcohol, which may cause allergic reactions. Use with caution in hepatic or renal impairment, or in patients who are pregnant or breast feeding, because of the risk of accumulation and toxicity (metabolic acidosis). If IMODIUM® Instant Melts are being used to control episodes of diarrhoea associated with Irritable Bowel Syndrome, consult a doctor if clinical improvement is not seen within 48 hours, for any changes in the pattern of symptoms or if there is a need for continuous treatment of more than 2 weeks. Patients should consult a doctor if aged 40 or over where it is some time since their last IBS attack or if symptoms differ to previous episodes; in cases of severe constipation; weight loss or loss of appetite; pain passing urine; blood is present in stools; episode after recent travel abroad. Cardiac events have been reported in association with overdose. Some cases with extremely high doses had a fatal outcome. Loss of consciousness, depressed level of consciousness, tiredness, dizziness, or drowsiness may occur when diarrhoea is treated with loperamide. Therefore, it is advisable to use caution when driving a car or operating machinery. Cardiac events including QT interval and QRS complex prolongation and torsades de pointes have been reported in association with overdose. Overdose can unmask existing Brugada syndrome. Patients should not exceed the recommended dose and/or the recommended duration of treatment. Caution is needed in patients with a history of drug abuse. Abuse and misuse of loperamide, has been described. Upon cessation, cases of drug withdrawal syndrome have been observed in individuals abusing, misusing, or intentionally overdosing with excessively large doses of loperamide. Loperamide is an opioid with low bioavailability and limited potential to penetrate the blood brain barrier at therapeutic doses. However, addiction is observed with opioids as a class. Pregnancy and lactation: Not recommended. Side Effects: Common: The most commonly reported adverse drug reactions in clinical trials in acute diarrhoea were: constipation (2.7%), flatulence (1.7%), headache (1.2%) and nausea (1.1%). Uncommon: dizziness; somnolence; abdominal pain or discomfort; dry mouth; vomiting; dyspepsia; rash. Rare: hypersensitivity reaction; anaphylactic reaction (including anaphylactic shock); anaphylactoid reaction; loss of consciousness; stupor; depressed level of consciousness; hypertonia; coordination abnormality; miosis; ileus (and paralytic ileus); megacolon (and toxic megacolon); glossodynia; abdominal distension; bullous eruption (including Stevens-Johnson syndrome, toxic epidermal necrolysis and erythema multiforme); angioedema; urticaria; pruritis; urinary retention; fatigue. Not Known: Acute pancreatitis. RRP (ex-VAT): 12 tablets, £7.03, 18 tablets £9.68 Legal Category: P PL Holder: McNeil Products Ltd., 50-100 Holmers Farm Way, High Wycombe, Buckinghamshire, HP12 4EG PL Number: 15513/0346 Date of Preparation: 09 January 2024
IMODIUM® Dual action Relief Tablets (Formerly IMODIUM® Plus Caplets) (loperamide hydrochloride)
Presentation: White, capsule-shaped tablet containing loperamide hydrochloride 2mg and simeticone equivalent to 125mg dimeticone. Indications: Symptomatic treatment of acute diarrhoea in adults and adolescents over 12 years when acute diarrhoea is associated with gas-related abdominal discomfort including bloating, cramping or flatulence. Dosage and Administration: Swallow the correct number of tablets whole with a drink of water. Adults over 18 years: Take 2 tablets initially, followed by 1 tablet after every loose stool. Adolescents aged 12-18 years: Take 1 tablet initially followed by 1 tablet after each loose stool. Not more than 4 tablets should be taken in 24 hours, limited to no more than 2 days. Contraindications: Not to be used in children under 12 years of age, or patients with: hypersensitivity to loperamide or simeticone or to any of the excipients listed in SPC section 6.1; acute dysentery (characterised by blood in stool and high fever); acute ulcerative colitis; pseudomembranous colitis associated with broad spectrum antibiotics; bacterial enterocolitis caused by invasive organisms. Must not be used when inhibition of peristalsis is to be avoided. Therapy must be discontinued if constipation, ileus and/or abdominal distension develop. Precautions: Treatment of diarrhoea with loperamide-simeticone is only symptomatic; give specific treatment when appropriate. Upon cessation, cases of drug withdrawal syndrome have been observed in individuals abusing, misusing, or intentionally overdosing with excessively large doses of loperamide. In patients with severe diarrhoea, attention should be paid to appropriate fluid and electrolyte replacement. If clinical improvement is not seen within 48 hours, stop treatment and consult a doctor. Patients with AIDS should stop therapy if abdominal distension develops. Use under medical supervision in patients with hepatic dysfunction. Cardiac events including QT interval and QRS complex prolongation and torsades de pointes have been reported in association with overdose. Some cases had a fatal outcome. Overdose can unmask existing Brugada syndrome. Imodium Plus contains benzyl alcohol (less than 0.026 mg per tablet), which may cause allergic reactions. Imodium Plus must be used with caution in patients with renal or hepatic impairment, or in patients who are pregnant or breast-feeding, because of the risk of accumulation and toxicity (metabolic acidosis). This medicine contains maltodextrin (less than 4.4 mg per tablet) which contains glucose. Patients with rare glucose-galactose malabsorption should not take this medicine. Pregnancy and lactation: Not recommended. Fertility: Effect has not been evaluated. Ability to drive: Imodium Dual Action Relief has no or negligible influence on the ability to drive and use machines. However, tiredness, dizziness and drowsiness may occur in the setting of diarrheal syndromes treated with loperamide HCl. Therefore, it is advisable to use caution when driving a car or operating machinery. Side Effects: The most commonly reported adverse drug reactions in clinical trials were: dysgeusia (2.6%) and nausea (1.6%). Additionally, adverse drug reactions reported with the use of loperamide-simeticone from either clinical trial or post-marketing experience and with the use of loperamide HCl are: Common: Headache. Uncommon: Somnolence, dizziness, abdominal pain, abdominal discomfort, abdominal pain upper, vomiting, constipation, abdominal distension, dyspepsia, flatulence, dry mouth, rash and asthenia. Rare: Hypersensitivity reaction, anaphylactic reaction (including anaphylactic shock), anaphylactoid reaction, loss of consciousness, depressed level of consciousness, stupor, hypertonia, coordination abnormality, miosis, ileus (including paralytic ileus), megacolon (including toxic megacolon), bullous eruption (including Stevens-Johnson syndrome, toxic epidermal necrolysis and erythema multiforme), angioedema, urticaria, pruritus, urinary retention and fatigue. Not known : Acute pancreatitis. RRP (ex-VAT): 12 tablets, £6.58 Legal Category: P PL Holder: McNeil Products Ltd, 50 – 100 Holmers Farm Way High Wycombe Buckinghamshire HP12 4EG UK PL Number: 15513/0342 Date of Preparation: 04 April 2023.
Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard
Adverse events should also be reported to McNeil Products Limited on 01344 864042.
Content developed by Kenvue working together with CIG Healthcare Partnership. © 2024 CIG Healthcare Partnership
UK-IM-2400062 June 2024