People are abusing anti-diarrheal medication, sold under the brand name Imodium A-D, to get high. This can result in serious heart problems or even death (Food and Drug Administration, 2018).
The ingredient loperamide is included in the anti-diarrheal medication. Loperamide is in the opioid family which includes morphine and oxycodone (AP, 2018). Because of this the Food and Drug Administration is working with the producers of anti-diarrheal medications to limit the loperamide dose that is contained in over the counter (OTC) packages (Food and Drug Administration, 2018). The FDA suggest the manufacturers use single dose packages or blister packs to help limit the customer’s opioid intake. A spike in overdoses of anti-diarrheal drugs have forced drug companies to take the FDA’s suggestion seriously.
While the FDA approved anti-diarrheal drug binds to opiate receptors in the stomach wall and slows down peristalsis, reducing diarrhea, the OTC version has other dangerous side effects. Loperamide, which is 50 times more potent than the FDA approved morphine, is considered by some as the “poor man’s heroin.” Addicts take the OTC medication to prevent withdrawal symptoms or to achieve a euphoric opioid high (Borron, Watts et al, 2017). To maintain this, they might take anywhere between 200 to 400mg per day (Borron et al, 2017), despite the maximum suggested daily dose for adults taking OTC drugs is 8mg per day and 16mg per day for prescription drugs (Food and Drug Administration, 2018).
From 1985 to 2016, 54 case reports were published regarding loperamide toxicity (Miller, Panaj et al, 2017). The number of reports published per year has increased by more than tenfold in 2014 (Miller et al., 2017). Males account for 35 of the 54 cases reported (Miller et al., 2017). Additionally, 25- to 34-year-olds account for most of the loperamide toxicity case reports. During the years between 1985 and 2013, the primary reason for loperamide overdose was for relief of diarrhea (Miller et al., 2017). Between the years of 2014 and 2016 loperamide usage increased because the drug was being used as an opioid alternative (Miller et al., 2017).
The FDA has received 48 reports of cases of serious heart problems associated with the use of loperamide. Ten patients have died from misuse or abuse of the OTC medication (Food and Drug Administration, 2018). The FDA is taking measures to help in the reduction of loperamide abuse to limit preventable consumer illness and fatality.
For more information on this topic read “FDA Seeks to Curb Abuse of Common Anti-Diarrhea Drugs.”
Associated Press. (2018). FDA Seeks to Curb Abuse of Common Anti-Diarrhea Drugs. Retrieved from https://www.pressherald.com/2018/01/30/fda-seeks-to-curb-abuse-of-common-anti-diarrhea-drugs
Borron, S.W., Watts, S.H., Tull, J., Baeza, S., Diebold, S., Barrow, A. (2017). Intentional Misuse and Abuse of Loperamide: A New Look at a Drug with “Low Abuse Potential.” The Journal of Emergency Medicine, Volume 53, Issue 1, 73-84. doi: 10.1016/jemermed.2017.03.018
Food and Drug Administration. (2018). FDA Drug Safety Communication: FDA limits packaging for anti-diarrhea medicine Loperamide (Imodium) to encourage safe use. Retrieved from https://www.fda.gov/Drugs/DrugSafety/ucm594232.htm
Miller, H., Panahi, L., Tapia, D., Tran, A., Bowman, J.D. (2017). Loperamide misuse and abuse. Journal of the American Pharmacists Association, 57(2017) S45-S50. Retrieved from http://www.japha.org/article/S1544-3191(16) 31028-7/pdf