Is there any interaction between Imodium and zoloft? 

In this blog, we are going to talk about the possible interactions between Imodium and zoloft. Zoloft is an antidepressant which often causes diarrhoea as a side effect. 

Imodium, being an antidiarrheal agent, is often used to treat that condition. This blog will help us understand if it’s safe to use the two meds together and if yes, then how much. 

Is there any interaction between Imodium and zoloft? 

A few clinical trials revealed that imodium can decrease the metabolism of zoloft. Higher doses can cause cardiac complications, including QT prolongation and arrhythmia. Imodium can still be taken while using zoloft, if your healthcare provider prescribes it. 

When are Imodium and zoloft used together?

Zoloft is well known for causing gastrointestinal side effects, one of which include diarrhoea. 

When zoloft increases the level of serotonin, it stimulates serotonin receptors in the GI tract as well, which results in increased firing rate of the secretomotor neurons and an increase in intestinal motility and secretion. 

This increased intestinal motility results in diarrhoea. Side effects of zoloft usually begin to subside within a few weeks of treatment, but diarrhoea is a bit problematic. 

It makes you nauseous, hurts your stomach, makes you dehydrated and electrolyte deficient. It sometimes needs medication to help relieve the symptoms. 

Imodium, brand name for loperamide, is one of the most commonly used drugs to help relieve the symptoms of diarrhoea and irritable bowel syndrome (IBS). 

It basically slows down your intestinal motility, which can slow down the movement of water and food. This helps in better absorption of water and nutrients and also makes your stool less watery. 

It is a common practice to take imodium while taking zoloft. If two meds have a potential to interact, it doesn’t always mean that they should be avoided. The dose at which you take these meds and timing matter a lot.

First you need to know that mild diarrhoea does not need medication. There are plenty of non-pharmacological ways (Discussed later in this blog) to make it go away. 

If your diarrhoea persists, then your doctor suggests you take the med. The dose is usually adjusted and it is advised to take imodium at night if you’re taking zoloft in the morning and vice versa. This avoids the high concentration of both these drugs in your system at the same time. 

What are the side effects of imodium and zoloft? 

Both drugs have side effects of their own. It is important to make sure your doses are not too high, or you will suffer from synergistic side effects

Imodium 

Following are the side effects of imodium:

• Drowsiness 
• Fatigue 
• Lightheadedness
• Constipation 
• Stomach pain
• Increased heart rate
• Bloating and Flatulence 
• Feeling of fullness in stomach

Serious side effects include:

• Allergic reaction to imodium, including a very bad skin rash, mouth or tongue swelling, chest tightness, improper breathing etc. 
• Dangerously fast heart rate
• Arrhythmia 
• Excessive sweating and extreme dizziness 
• Unconsciousness 

Make sure you look out for the above mentioned side effects and inform your healthcare provider right away if the drug doesn’t seem to suit you. The side effects are most commonly dose dependent, unless you’re allergic to the active ingredient of imodium, that is loperamide. 

Zoloft

Common side effects of Zoloft include:

• Loss of appetite
• Tiredness
• Feeling angry or agitated
• Weight gain
• Inability to digest food
• Nausea
• Diarrhoea
• Loss of libido
• Sweating/Night sweats
• Tremors or shaking
• Insomnia
• Decreased sex drive
• Impotence
• Inability to ejaculate

Zoloft, sometimes, causes serious side effects. Consult your healthcare provider as soon as you can if these symptoms occur:

• Seizure/convulsions
• Eye pain with vision problems
• Headache
• Confusion
• Agitation
• Memory problems/Dementia 
• Severe weakness and inability to move

Non-Pharmacological ways to help relieve the symptoms of zoloft induced diarrhoea 

There are plenty of natural ways to ease the symptoms of your diarrhoea, but they are not helpful in severe diarrhoea which require suitable medication and proper supplements to help replenish the lost nutrients. 

Avoid caffeine and alcohol 

Caffeine acts as a stimulant and it is known to increase intestinal motility. Consuming coffee while suffering from diarrhoea is the worst thing you can do. It will upset your stomach even more and increase the frequency of your loose and watery stools.

It is also recommended to avoid alcohol, as it can contribute to other side effects of zoloft and can exacerbate diarrhoea vomiting. Stick to water and healthy non-carbonated beverages. 

Use probiotics 

Probiotics should be considered a must, when dealing with meds that upset your stomach. They are actually ‘good’ bacteria which reside naturally in your gut. 

In case of diarrhoea, most of these bacteria are lost because of watery stools. The addition of probiotics will help replenish those good bacteria and bring your stomach back to its normal state. 

Natural sources of probiotics include nuts, yoghurt, asparagus, garlic, onions, leeks, banana, barley, oats, apples, cocoa, wheat bran, flaxseeds etc. Add these in your diet while being on zoloft, to strengthen your gut bacteria. 

Electrolyte replenishers

Diarrhoea is strongly associated with dehydration along with loss of electrolytes. This causes extreme weakness, sometimes up to the point where you no longer have energy to even get up from your bed. 

In this condition, it is advised to drink lots and lots of fluids. Electrolyte replenishers are also used which contain various electrolytes like sodium, potassium, chloride ions, bicarbonate ions etc, which might have been eliminated from your body along with your stools.

Oral rehydration therapy is also used. Electrolyte drinks usually contain salts of sodium or potassium, which make up for the amount of these minerals lost from the body.

Eat bland foods 

People with diarrhoea should eat bland foods, as spicy or complex foods can irritate the bowels. Bland foods that may help with diarrhoea include:

• Banana 
• Applesauce
• Softly boiled white rice
• White bread 
• Boiled or mashed potatoes
• Plain crackers

Avoid foods that can worsen your diarrhoea 

It is best to avoid following foods while experiencing diarrhoea

• Dairy products
• Fried, fatty, greasy foods
• Spicy foods
• Processed foods
• Red meat like veal
• Sardines
• Raw vegetables
• Rhubarb
• Onions
• Corn
• Alcohol
• Coffee
• Soda
• Sorbitol and other artificial sweeteners

Avoid other drugs that can contribute to your diarrhoeal symptoms

It’s best to avoid other medications which have a potential to cause diarrhoea. These include:

• Antibiotics
• Metformin
• Beta blockers
• ACE inhibitors 
• angiotensin receptor blockers (ARBS)
• Colchicine
• Digoxin
• Colchicine
• Lithium
• Vitamins like magnesium and vitamin C
• Non steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve)

When to call your doctor 

While using imodium and zoloft together, it is important to call your healthcare provider right away if you:

• Notice abnormally fast heart rate
• Feel nauseous and dizzy
• Become breathless and feel tightness in your chest
• Begin to notice much more pronounced side effects of zoloft 
• Suffer from abdominal pain

Conclusion 

In this blog, we discussed the possible interactions between Imodium and zoloft. We took data from a few clinical trials which indicated that imodium and zoloft in combination might result in unusually fast heart rate and QT elongation. 

Imodium can also slow down the metabolism of zoloft and can make it available inside the body for a longer period of time. These interactions can be avoided if the dose is adjusted and the drugs are taken at different times. 

Make sure you don’t start the use of imodium on your own when you begin to notice the signs of zoloft induced diarrhoea. Mild diarrhoea does not require pharmacological treatment. 

If your diarrhoea becomes severe, that’s when your healthcare provider will advise you to start taking imodium at a dose which will not interfere with zoloft in any way possible. 

FAQs: Imodium and zoloft 

How do I stop diarrhoea when taking sertraline?

Following are a few remedies that can help relieve the symptoms of diarrhoea:

• Drink plenty of fluids like water, oral hydration solutions (ORS), soup etc. 
• Consume liquid calories like milkshakes, smoothies etc. 
• Avoid spicy foods, which can irritate your stomach and exacerbate the symptoms of diarrhoea. 
• Eat plenty of probiotics. In case of diarrhoea, yoghurt is considered a good choice. It cools down your stomach and adds natural probiotics to replenish your lost gastrointestinal microflora. 
• Avoid alcohol and caffeine. 

What medications should not be taken with Zoloft?

• Do you use zoloft with any irreversible monoamine oxidase inhibitors (MAOIs). Concomitant treatment is highly contraindicated due to the risk of serotonin syndrome with symptoms like agitation, tremor and hyperthermia. 
• Do not use zoloft with pimozide. Combining these medications can increase the plasma concentration(availability of a drug in the blood) of pimozide to much higher levels. It can result in life-threatening arrhythmia.
• Zoloft also interacts with tryptophan, St. John’s wort, meperidine, tramadol, cimetidine and warfarin. 

What medications should not be taken with Imodium?

Avoid taking the following medications with imodium:

• Anti-anxiety medications, including benzodiazepines, barbiturates etc. 
• Antipsychotics, including clozapine, olanzapine etc) 
• Antiepileptics, including carbamazepine, sodium valproate etc. 
• Antimalarial drugs, including chloroquine 
• Antifungals, including itraconazole, fluconazole etc. 
• Some antibiotics, including macrolides (erythromycin, clarithromycin, azithromycin etc) 
• Antiemetics, including domperidone, ondansetron etc
• Tricyclic antidepressants, including amitriptyline, nortriptyline etc. 

Can Zoloft cause severe diarrhoea?

Yes, zoloft can indeed cause diarrhoea. When SSRIs increase the level of serotonin, they stimulate serotonin receptors in the GI tract as well. It results in increased serotonin activity. 

It causes an increase in firing rate of the secretomotor neurons and an increase in intestinal motility and secretion. This increased intestinal motility results in diarrhoea.

The severity of zoloft induced symptoms differ from person to person. It depends on how your body reacts to it. For some, it’s quite tolerable. Always contact your healthcare provider if you notice any unusual symptom. 

What time of day is best to take Zoloft?

The ideal time of zoloft should be recommended by your healthcare provider, according to your side effects and the kind of lifestyle you have.

You can set the best time for zoloft, in accordance with your side effects:

• If it causes insomnia, morning is preferred.
• If it causes drowsiness, night time is preferred.
• If it causes nausea, night time is preferred.
• If it causes urinary problems, morning is preferred.
• If it causes loss of libido, morning is preferred.

Can Zoloft cause IBS symptoms?

Zoloft is often used to treat the symptoms of IBS. This treatment is most commonly used in people who have IBS associated anxiety and depression. Zoloft can alter the levels of neurotransmitters in your brain and gut. This effect was found to be helpful in patients with IBS.

References 

• Imodium and Zoloft drug interactions – a phase IV clinical study of FDA data https://www.ehealthme.com/drug-interaction/imodium/zoloft/ 
• Drug Interactions between Imodium and sertraline https://www.drugs.com/drug-interactions/imodium-with-sertraline-1482-14224-2057-0.html 
• Imodium interactions https://www.medbroadcast.com/drug/getdrug/imodium 
• Pharmacological advice for sertraline and loperamide https://epha.health/clinic/advice/en/for-drug-sertralin-loperamid/
• Sahi N, Nguyen R, Santos C. – Loperamide https://www.ncbi.nlm.nih.gov/books/NBK557885/
• Singh HK, Saadabadi A. – Sertraline https://www.ncbi.nlm.nih.gov/books/NBK547689/