Oral loperamide abuse postings to web-based forums increased tenfold between 2010 and 2011. A majority of user-generated content pertaining to loperamide reported using the medication to self-treat opioid withdrawal (70 percent).³ Users also cited abusing the medication for its euphoric properties (25 percent). The Upstate New York Poison Center experienced a sevenfold increase in calls related to loperamide abuse or misuse from 2011 through 2015. That is consistent with national poison data, which reported a 71 percent increase in calls related to intentional loperamide exposure from 2011 through 2014.

If the dose does make the poison, then it won’t come as a surprise to most clinicians that 100 times the therapeutic dose of almost anything, including loperamide, would cause toxicity.

Dr. LoVecchio is vice-chairman and research director for Maricopa Medical Center and co-medical director for Banner Poison and Drug Information Center, both in Phoenix, and professor of emergency medicine at The University of Arizona in Tucson.

References

1. Eggleston W, Clark KH, Marraffa JM. Loperamide abuse associated with cardiac dysrhythmia and death (published online ahead of print April 26, 2016). Ann Emerg Med. doi:10.1016/j.annemergmed.2016.03.047.
2. FAERS Reporting by Healthcare Providers and Consumers by Year. U.S. Food and Drug Administration website. Accessed July 11, 2016.
3. Dierksen J, Gonsoulin M, Walterscheid JP. Poor man’s methadone: a case report of loperamide toxicity. Am J Forensic Med Pathol. 2015;36(4):268-270.