Betel Nut - Imodium (Loperamide) Interaction
Herbal: Betel Nut
Drug: Loperamide
Brand names:
Imodium, Loperamide

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
May 18, 2025
Interaction Details
Loperamide is classified as belonging to the following category: Anticholinergic Drugs
In vitro and animal research suggests that betel nut extract can inhibit acetylcholinesterase activity. Additionally, in one case series, adults who were treated with procyclidine, an anticholinergic drug, and neuroleptics for the management of extrapyramidal symptoms (EPS) due to fluphenazine ultimately developed severe EPS, such as tremor and stiffness, thought to be related to betel nut use. Theoretically, concurrent use of anticholinergic drugs and betel nut might decrease the effectiveness of betel nut or the anticholinergic agent.
Some anticholinergic drugs include atropine, benztropine (Cogentin), biperiden (Akineton), procyclidine (Kemadrin), and trihexyphenidyl (Artane). Avoid concomitant use.
Interaction Rating
Likelihood of Occurrence
ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
References
- The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.
- Gilani, A. H., Ghayur, M. N., Saify, Z. S., Ahmed, S. P., Choudhary, M. I., and Khalid, A. Presence of cholinomimetic and acetylcholinesterase inhibitory constituents in betel nut. Life Sci 10-1-2004;75(20):2377-2389.
Loperamide Overview
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Nonprescription (over-the-counter) loperamide is used to control acute diarrhea (loose stools that come on suddenly and usually lasts less than 2 weeks), including travelers' diarrhea. Prescription loperamide is also used to control acute diarrhea and also ongoing diarrhea associated with inflammatory bowel disease (IBD; condition in which the lining of all or part of the intestine is swollen, irritated, or has sores). Prescription loperamide is also used to reduce the amount of fluid in people with ileostomies (surgery to create an opening for waste to leave the body through the abdomen). Loperamide is in a class of medications called antidiarrheal agents. It works by decreasing the flow of fluids and electrolytes into the bowel and by slowing down the movement of the bowel to decrease the number of bowel movements.
Betel Nut - More Interactions
Betel Nut interacts with 226 drugs
Interaction Rating Key
These severity listings are for informational use only. Never start, stop or otherwise change your therapy before speaking with your provider.
Major | The combined use of these agents is strongly discouraged as serious side effects or other negative outcomes could occur. |
Moderate | Use cautiously under the care of a healthcare professional or avoid this combination. A significant interaction or negative outcome could occur. |
Minor | Be aware that there is a chance of an interaction. Watch for warning signs of a potential interaction. |
Unknown | No interactions have been reported or no interaction data is currently available. |
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DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.
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Drug descriptions are provided by MedlinePlus.