Fact Sheets

Sharing fact sheets with your colleagues helps alert more healthcare providers to the possibility of loperamide abuse by their patients.

Media Guidance

Responsible reporting is an important aspect of communicating about public health issues. The document below provides guidance on hour journalists and other members of the media can avoid sensationalizing loperamide abuse and misuse and limit the risk of contagion. Please share this guidance with any journalist who approaches you about loperamide abuse or misuse.

Download the media guidance.

Literature

FDA Communications

Loperamide is approved by the U.S. Food and Drug Administration and remains available over the counter. FDA has released the following communications on loperamide.

FDA Drug Safety Communications

• Jan. 30, 2018 – FDA limits packaging for anti-diarrhea medicine loperamide (Imodium) to encourage safe use

• June 7, 2016 – FDA warns about serious heart problems with high doses of the antidiarrheal medicine loperamide (Imodium), including from abuse and misuse

FDA Voices

• May 9, 2018 – Emerging issues of misuse and abuse of OTC loperamide challenge FDA to address a new turn in the opioid addiction crisis, while maintaining access for patients

FDA in Brief

• Sept. 20, 2019 – FDA approves new packaging for brand-name over-the-counter loperamide to help curb abuse and misuse

Peer-Reviewed Journal Articles and Case Studies

2020

• Shastay A. Dangerous abuse of a 40-year-old over-the-counter medication, loperamide. Home Healthc Now. 2020;38(3):167-168. doi.org/10.1097/nhh.0000000000000871.

• Webb NE, Wood DM, Black JC, Amioka E, Dart RC, Dargan PI. Non-medical use of loperamide in the UK and USA. QJM. 2020;113(1):25-30. doi:10.1093/qjmed/hcz215.

2019

• Al-Khatib J, Vindhyal SR, Boppana VS, Vindhyal MR. Ventricular tachycardia storm induced by loperamide abuse. Cureus. 2019;11(1):e3981. doi:10.7759/cureus.3981.

• Arnold C, Martinez CJ. Loperamide overdose. Cureus. 2019;11(5):e4753. doi:10.7759/cureus.4753.

• Bornstein K, Montrief T, Parris MA. Left ventricular regional wall motion abnormality in the setting of acute loperamide overdose. Clin Pract Cases Emerg Med. 2019;3(3):262-266. doi:10.5811/cpcem.2019.4.42510.

• Cicci JD, Jagielski SM, Clarke MM, Rayson RA, Cavender MA. Loperamide overdose causing torsades de pointes and requiring Impella temporary mechanical support: a case report. Eur Heart J Case Rep. 2019. Ytz150, doi.org/10.1093/ehjcr/ytz150

• Kim S. The unsuspected threat of three opioid-like substitutes. Arch Psychiatr Nurs.2019;33(4):325-328. doi:0.1016/j.apnu.2019.01.003.

• Kohli U, Altujjar M, Sharma R, Hassan S. Wide interindividual variability in cardiovascular toxicity of loperamide: A case report and review of literature. HeartRhythm Case Rep 2019; 5:221-224. doi:10.1016/j.hrcr.2019.01.004.

• Parker BM, Rao T, Matta A et al. Loperamide induced cardiac arrhythmia successfully supported with veno-arterial ECMO (VA-ECMO), molecular adsorbent recirculating system (MARS) and continuous renal replacement therapy (CMMT). Clin Toxicol. 2019;57(11):1118-1122. doi:10.1080/15563650.2019.1580370.

• Riaz IB, Khan MS, Kamal MU, et al. Cardiac Dysrhythmias Associated with Substitutive Use of Loperamide: A Systematic Review. Am J Ther. 2019; 26:e170-e182. doi:10.1097/MJT.0000000000000585.

• Tausch K, Clark E, Getzinger KK, Jones SC. A costly way to get a cheap high. Emergency Medicine News. 2019;41(6B). doi:10.1097/01.EEM.0000558400.06772.0b.

• Teigeler T, Stahura H, Alimohammad R, et al. Electrocardiographic changes in loperamide toxicity: Case report and review of literature. J Cardiovasc Electrophysiol. 2019. doi:10.1111/jce.14129.

• White CM. Loperamide: A readily available but dangerous opioid substitute. J Clin Pharmacol. 2019;59(9):1159-1284. doi:10.1002/jcph.1449.

• Wolfrum LA, Nordmeyer AS, Racine CW, Nichols SD. Loperamide-associated opioid use disorder and proposal of an alternative treatment with buprenorphine. J Addict Med. 2019;13(3):245-247. doi:10.1097/ADM.0000000000000472.

2018

• Farrugia LA, Rhyee SH, Campleman SL et al. The Toxicology Investigators Consortium Case Registry-the 2017 Annual Report. J Med Toxicol. 2018; 14:182-211. doi:10.1007/s13181-018-0679-z.

• Larsen TR, McMunn J, Ahmad H, et al. Ventricular Tachycardia Triggered by Loperamide and Famotidine Abuse. Drug Saf – Case Rep. 2018;5:11. doi:10.1007/s40800-018-0077-0.

• Lee VR, Vera A, Alexander A, et al. Loperamide misuse to avoid opioid withdrawal and to achieve a euphoric effect: high doses and high risk. Clin Toxicol (Phila). December 2018:1-6. doi:10.1080/15563650.2018.1510128.

• Mittal A, Sangani R, Cerone M, et al. Seizur-Like Activity and Recurrent Cardiac Arrests in a Healthy 24-Year-Old: Loperamide Abuse; a Case Report and Literature Review. CHEST. 2018;152(4):A386. doi:10.1016/j.chest.2017.08.412

• Olofinsan KA, Ajala-Lawal RA, Ajiboye TO. Loperamide-induced cardiotoxicity in rats: Evidence from cardiac and oxidative stress biomarkers. J Biochem Mol Toxicol. December 2018:e2228. doi:10.1002/jbt.22278.

• Prazak AM, Barker B. Long-term Use of High-Dose Loperamide Leading to Cardiac Arrest and Ventricular Arrhythmias. Critical Care Medicine. 2018;46(1):91. doi:10.1097/01.ccm.0000528236.02069.da.

• Rojas SF, Bonilla HG, Oglet A, et al. Loperamide Induced Brugada Pattern. Journal of the American College of Cardiology. 2018;71(11):A2598. doi:10.1016/S0735-1097(18)33139-5.

• Zaman MO, Ali MU, Finkel J, et al. A Case of Loperamide Induced Cardiac Syncope. Journal of the American College of Cardiology. 2018;71(11):A2550. doi:10.1016/S0735-1097(18)33091-2.

2017

• Antoniou T, Juurlink, D. Loperamide abuse. CMAJ. June 2017;189(23):E803. doi:10.1503/cmaj.161421.

• Borron SW, Watts SH, Tull J, et al. Intentional misuse and abuse of loperamide: a new look at a drug with “low abuse potential.” J Emerg Med. 2017;53:1–12. doi:10.1016/j.jemermed.2017.03.018.

• Eggleston W, Clark KH, Marraffa JM. Loperamide abuse associated with cardiac dysrhythmia and death. Ann Emerg Med. 2017;69(1):83–86. doi:10.1016/j.annemergmed.2016.03.047.

• Lasoff DR, Koh CH, Corbett B, et al. Loperamide trends in abuse and misuse over 13 years: 2002-2015. Pharmacotherapy. February 2017;37(2):249–253. doi: 10.1002/phar.1885.

• Miller H, Panahi L, Tapia D, et al. Loperamide misuse and abuse. J Am Pharm Assoc. 2017;57:S45–S50. doi:10.1016/j.japh.2016.12.079.

• Swank KA, Wu E, Kortepeter C, et al. Adverse event detection using the FDA post-marketing drug safety surveillance system: cardiotoxicity associated with loperamide abuse and misuse. J Am Pharm Assoc. 2017;57:563–567. doi:10.1016/j.japh.2016.11.011.

• Vithalani ND, Heron C, Rao RE, et al. Dysrhythmias with Loperamide Used for Opioid Withdrawal. J Am Board Fam Med. 2017;30(6):832–834. doi:10.3122/jabfm.2017.06.170066.

• Wu PE, Juurlink DN. Clinical review: loperamide toxicity. Ann Emerg Med. August 2017;70(2):245–252. doi:10.1016/j.annemergmed.2017.04.008.

2016

• Bishop-Freeman SC, Feaster MS, Beal J, et al. Loperamide-related deaths in North Carolina. J Anal Toxicol. 2016;40(8):677–686. doi:10.1093/jat/bkw069.

• Klein MG, Haigney MCP, Mehler PS, Fatima N, Flagg TP, Krantz MJ. Potent Inhibition of hERG Channels by the Over-the-Counter Antidiarrheal Agent Loperamide. JACC Clin Electrophysiol 2016; 2:784-789. doi:10.1016/j.jacep.2016.07.008.

• O'Connell CW, et al. High-dose loperamide abuse–associated ventricular arrhythmias. Heart Rhythym Case Rep 2016; 2:232-236. doi:10.1016/j.hrcr.2016.01.002.

2015

• 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. doi:10.1097/PAF.0000000000000201.

2014

• Marraffa JM, Holland MG, Sullivan RW, et al. Cardiac conduction disturbance after loperamide abuse. Clinical Toxicology. 2014;52:952957. doi:10.3109/15563650.2014.969371.

2013

• Daniulaityte R, Carlson R, Falck R, et al. “I just wanted to tell you that loperamide WILL WORK”: a web-based study of extra-medical use of loperamide. Drug Alcohol Depend. 2013;130(1-3):241–244. doi:10.1016/j.drugalcdep.2012.11.003.