Drug list
GASTROINTESTINAL DRUGS › ANTIDIARRHEA AGENTS

LOPERAMIDE HCL (Apo-Loperamide · Imodium · PMS-Loperamide · Teva-Loperamide)

2mgCaplet

For the treatment of diarrhea associated with:

LU110
QUICK SCAN

An ileostomy or a colostomy;.

LU Authorization Period: 1 year
Complete Ontario criteria

An ileostomy or a colostomy;.

LU111
QUICK SCAN

Bowel resection, including short bowel syndrome;

LU Authorization Period: 1 year
Complete Ontario criteria

Bowel resection, including short bowel syndrome;

LU112
QUICK SCAN

Inflammatory Bowel Diseases, i.e.

LU Authorization Period: 1 year
Complete Ontario criteria

Inflammatory Bowel Diseases, i.e. Crohn's Disease and Ulcerative Colitis;

LU113
QUICK SCAN

Cancer, including chemotherapy or radiation therapy;

LU Authorization Period: 1 year
Complete Ontario criteria

Cancer, including chemotherapy or radiation therapy;

LU114
QUICK SCAN

HIV/AIDS;

LU Authorization Period: 1 year
Complete Ontario criteria

HIV/AIDS;

LU115
QUICK SCAN

Acute diarrhea in patients in congregated housing, i.e.

LU Authorization Period: 1 year
Complete Ontario criteria

Acute diarrhea in patients in congregated housing, i.e. Long Term Care Facilities (LTCF), or for patients receiving Home Care;

LU224
QUICK SCAN

Fecal incontinence.

LU Authorization Period: 1 year
Complete Ontario criteria

Fecal incontinence.

Clinical verification required

Quick summaries support scanning only. Confirm eligibility against the complete Ontario criteria and current Ontario e-Formulary before billing.

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