MDLinxPatients Abuse this Laxative for an Opiate-like High

Abuse of OTC Loperamide: Implications for Opioid Users and Cardiac Health Risks

Patients are increasingly abusing loperamide, an over-the-counter antidiarrheal, to achieve opioid-like effects at high doses. This practice has resulted in severe health complications, including cardiac toxicity. This summary provides crucial information for clinicians on recognizing and managing loperamide abuse and highlights the necessity for careful screening and appropriate referrals for substance use disorder treatment.

Key Points:

• Loperamide Abuse Overview:
  • Loperamide, commonly used for diarrhea, is being abused for its opioid-like effects when taken in large quantities.
  • Abuse is prevalent among individuals with a history of opioid use disorder.
• Health Risks:
  • High doses of loperamide can lead to severe cardiac issues such as QTc prolongation, syncope, and cardiac arrest.
  • Symptoms of loperamide toxicity may include arrhythmias, fainting, and potentially fatal cardiac events.
• Clinical Management:
  • Acute toxicity requires symptomatic treatment, including the use of activated charcoal to limit absorption if presented early.
  • Naloxone can be administered for respiratory depression but may require higher doses than usual.
• Screening and Diagnosis:
  • Clinicians should screen for loperamide abuse in patients with a history of opioid use, particularly if presenting with unexplained cardiac symptoms.
  • Toxicology screening may help identify loperamide in patients with suspected abuse.
• Substance Use Disorder Treatment:
  • Chronic abusers should be referred to specialized substance use disorder treatment centers.
  • Comprehensive treatment plans should address the underlying opioid use disorder.
• Preventive Measures:
  • Educating patients about the dangers of loperamide abuse and providing resources for addiction support can help prevent misuse.
  • Regulatory measures may be needed to control the sale and availability of loperamide.

Studies assessed the 2010-2015 US National Poison Data System loperamide exposures and identified a 91% increase of cases over time with interestingly loperamide being the sole agent in 50% of the cases. (Annals of Emergency Medicine)

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