Drug Interaction Report

Loperamide and Ulipristal: Interaction Details

A pharmacist-reviewed analysis of the Loperamide and Ulipristal interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Ulipristal

Ella Ella®
+

Loperamide

Diamode Imodium Imodium® Imodium® AD Imotil® K-Pek II® Kao-Paverin® Kaopectate 1-D®
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
LinkedIn
Interaction severity
Major
Potentially serious — often needs a change or close monitoring.
How we grade severity & evidence

Severity levels

  • Contraindicated: These should generally not be used together.
  • Major: Potentially serious — often needs a change or close monitoring.
  • Moderate: Can be significant — usually manageable with monitoring.
  • Minor: Usually limited clinical impact.

Evidence grades

  • Established: Well documented — supported by controlled studies or strong clinical data.
  • Probable: Good supporting evidence, though not definitively proven.
  • Suspected: Some evidence suggests this interaction, but it is not well established.
  • Possible: Limited or conflicting evidence; the interaction may occur.
  • Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.

Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.

Of 429 documented Loperamide interactions, 406 are rated major — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
unspecified
Evidence
theoretical
Severity
Major

What happens

Increased loperamide exposure

Interaction Deep Dive

Concomitant use of loperamide with hormonal contraceptives, such as ulipristal (CYP3A4 inhibitors) may increase loperamide exposure and increase a risk for cardiac adverse reactions. Monitor patients for cardiac adverse reactions1. In vitro data suggests that ulipristal may inhibit the P-gp efflux transport system 2.

Why it happens (mechanism)

Inhibition of P-gp-mediated efflux of loperamide; inhibition of CYP3A4-mediated metabolism of loperamide

Literature reports

2 reports — tap to read

a) When multiple doses of both 100 mg itraconazole (CYP3A4 inhibitor) and 600 mg gemfibrozil twice daily were administered with a single 4 mg dose of loperamide hydrochloride, the mean peak plasma concentration and the systemic exposure to loperamide was increased by 4.2-fold and 12.6-fold, respectively 1.

b) Concomitant administration of multiple doses of 100 mg itraconazole twice daily (CYP3A4 inhibitor) with a single 4 mg dose of loperamide hydrochloride increased the peak plasma concentration and the systemic exposure to loperamide by 2.9-fold and 3.8-fold, respectively 1.

Common questions

Can I take Loperamide and Ulipristal together?

Increased loperamide exposure Always confirm with your pharmacist or prescriber before making any change.

How serious is the Loperamide and Ulipristal interaction?

It is rated major. Potentially serious — often needs a change or close monitoring.

How quickly could this interaction happen?

The documented onset is "unspecified". The timing of this interaction is not well characterized.

How strong is the evidence for this interaction?

The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.

Questions for your pharmacist

  • Does my dose of Loperamide or Ulipristal need adjusting while I take them together?
  • What symptoms should prompt me to call you or my prescriber right away?
  • Does the timing of my doses matter for this combination?
  • Is there a safer alternative to one of these medications for me?

References (2)

  1. Product Information: Loperamide hydrochloride oral capsules, loperamide hydrochloride oral capsules. Mylan Pharmaceuticals Inc (per DailyMed), Morgantown, WV, 2022. DailyMed
  2. Product Information: ELLA(R) oral tablets, ulipristal acetate oral tablets. Watson Pharma, Inc. (per FDA), Parsippany, NJ, 2012. DailyMed
Was this write-up helpful?
Ulipristal

Keep reading about Ulipristal

All Ulipristal interactions (31) Ulipristal drug information
Also serious with: Isotretinoin Mitapivat Meropenem Injection Nifedipine
Loperamide

Keep reading about Loperamide

All Loperamide interactions (429) Loperamide drug information
Also serious with: Mesoridazine Pimozide Ketoconazole Levoketoconazole
Beyond drug–drug

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

Loperamide + Activated Charcoal Henbane Scopolia St. John's Wort Angel's Trumpet Bacopa Belladonna Betel Nut + 74 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

Check another combination

Our instant two-drug interaction checker is almost here.

Coming soon

The instant two-drug checker is on its way.

In the meantime, browse the directory below to look up any drug and see its documented interactions.

Still have questions about this combination?

Every question gets a real answer from a licensed pharmacist — free, and usually within a day.

Ask the pharmacist
This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.