Loperamide Abuse

Loperamide is the generic name for Imodium, an antidiarrheal agent available both by prescription and over-the-counter. Loperamide is used for the management and symptomatic relief of acute non-specific diarrhea and chronic diarrhea correlated with inflammatory bowel disease (IBD). The medication is often recommended for decreasing the amount of discharge from ileostomy, which is a surgery that creates an opening for waste to exit the body through the abdomen.

Loperamide functions by slowing down the flow of fluids and electrolytes into the bowel and effectively reducing bowel movements and their frequency. The drug exists as either a pill, a capsule, or a liquid solution to be ingested by mouth.

Loperamide helps manage bowel movements and minimize dehydration in patients who have extreme, chronic, or acute diarrhea. In addition to these advantages, the medicine can often produce various harmful effects. These side effects can vary from mild to severe and may involve symptoms such as:

• Flatulence
• Dizziness
• Colic
• Vomiting
• Abdominal cramping
• Headache
• Nausea
• Drowsiness
• Constipation
• Problems urinating
• Dry mouth

The possibility of adverse effects is increased when the medication is abused, especially when large quantities of loperamide are ingested. Drug misuse has escalated dramatically over the last ten years, and several health officials relate this as a direct consequence of the opioid epidemic. Individuals who abuse loperamide do so as it creates similar effects to those of opioids and opiates when ingested at very high doses. Loperamide is an opioid agonist that causes a high by activating opioid receptors in the brain. The medication’s chemical makeup does not allow it to cross the blood-brain barrier at lower doses. Therefore, it would not produce a high unless taken in excessive quantities or in conjunction with other drugs.

Loperamide is an inexpensive medication, in comparison to the price of both illegal and pharmaceutical opioids. The cost of 200 capsules of standard loperamide may cost as low as $10. Individuals who misuse the drug purchase and consume between 50 and 400 tablets in a single day to generate a sense of euphoria similar to that of oxycodone and heroin.

“Loperamide’s accessibility, low-cost, over-the-counter legal status, and lack of social stigma all contribute to its high potential for abuse.”

— William Eggleston, PharmD, Upstate New York Poison Center Syracuse.

Many individuals also use loperamide to self-medicate during withdrawal symptoms correlated with opioid use disorders and to help relieve the physical dependency on opioids. Loperamide misuse is common and problematic that it has been nicknamed the “poor man’s methadone.” The use of loperamide as a substitute for opioids often involves extremely large doses of the medication being consumed and significantly contributing to a drug overdose. Ingesting massive and frequent amounts of loperamide poses a high risk of cardiac arrhythmias and respiratory depression, which may even lead to fatal consequences.

There is a widespread misconception that loperamide is safe since it is available over-the-counter. However, this is not true as large doses of any medication can contribute to the development of physical dependency. Prolonged consumption or higher doses of loperamide consumption, even for gastrointestinal or diarrheal pain management, can cause an individual to get accustomed to the medication’s presence in the system and develop an addiction to loperamide.

Once physical dependency has formed, users will experience painful withdrawal symptoms when deciding to quit the medication. These symptoms are similar to that experienced during opioid withdrawal, including:

• Nausea
• Fatigue
• Agitation
• Irritability
• Depression
• Cramping
• Diarrhea
• Heavy sweating
• Muscular aches and discomfort

Signs that show someone may have a loperamide addiction include:

• Spending much of the day thinking about loperamide.
• Constantly using the drug and being unable to quit its use.
• Faking symptoms for obtaining prescriptions of loperamide.
• Taking loperamide after it is no longer required or longer than prescribed.
• Needing more and more of the medication to produce the same effects.
• Substituting the medication for opioids to achieve a sense of euphoria or a high.
• Sudden changes in body appearance, hygiene, and behavior.

Another indication of loperamide addiction is the misuse of the medication in conjunction with other drugs to achieve intense euphoria. Alcohol is widely exploited alongside loperamide since it enhances the effects of both, causing the user to experience more intense intoxication. Engaging in such polydrug abuse increases the risk of a fatal overdose due to cardiotoxic effects.

• More Potent: Loperamide is about 40 to 50 times more potent than morphine in terms of CNS depressive and antidiarrheal effects produced.
• 71 Percent: Researchers have found a 71 percent increase in loperamide misuse calls to poison control centers across the US between 2011 and 2014.
• 10x Increase: As per the American College of Emergency Physicians, between 2010 and 2011, there was a 10-fold rise in online blog posts on oral loperamide abuse.

All medications, including those marketed as over-the-counter medications, can be unsafe unless they are administered as directed. Using loperamide to get high or ease the symptoms of opioid withdrawal is a form of drug abuse. There are various addiction recovery services available for loperamide addiction that involves detoxification programs, inpatient or outpatient rehab facilities, and aftercare programs. Patients are highly advised to seek medical and professional help when planning to cease loperamide use due to the severity of withdrawal symptoms.