Fact Sheets

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

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Emergency Healthcare Providers

Download this fact sheet to encourage emergency healthcare providers to consider loperamide abuse in their diagnosis.

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EMS PRactitioners

Download this fact sheet to educate emergency medical services practitioners about recognizing loperamide abuse.

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GASTROENTEROLOGISTS

Download this fact sheet to educate gastroenterology providers about recognizing loperamide abuse.

 
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BEHAVIORAL Healthcare Providers

Download this fact sheet to educate mental healthcare providers about preventing and recognizing loperamide abuse.

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Pharmacists

Download this fact sheet to educate pharmacists and other healthcare professionals in retail-based locations about loperamide packaging changes.

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General Healthcare Providers

Download this fact sheet to alert general healthcare providers to the possibility of loperamide abuse.

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Patients

Download this fact sheet if you believe a patient may benefit from learning about the risks of loperamide abuse.

 

Are You in Oklahoma?

Download a fact sheet to share with your colleagues and at-risk patients to educate them about the serious health risks of loperamide abuse.

Loperamide Safety in Oklahoma Logo
 
 

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

FDA Voices

FDA in Brief

 

Peer-Reviewed Journal Articles and Case Studies

    • Sahi N, Nguyen R, Santos C. Loperamide. In: StatPearls. Treasure Island (FL): StatPearls Publishing; March 20, 2023.

    • Giesing W, Koester C, Al-Akchar M, Kulkarni A, Labedi M. Loperamide-Induced Ventricular Tachycardia Storm. Avicenna J Med 2022;12:93-96. doi:10.1055/s-0042-1749628

    • Guinchat V, Ansermot N, Ing LK et al. Case Report: Opioid Use Disorder Associated With Low/Moderate Dose of Loperamide in an Intellectual Disability Patient With CYP3A and P-Glycoprotein Reduced Activity. Front Psychiatry 2022;13:910684. doi:10.3389/fpsyt.2022.910684

    • Jackson GG, Lopez CR, Bermudez ES et al. Loperamide Induced Recurrent Torsades de Pointes: A Case Report. J Pharm Pract 2022;35:791-795. doi:10.1177/08971900211004832

    • Tringale M, Hinson M, Reilly S, Sirois J. Using Online Listening Technology For Earlier Insights About Loperamide Abuse And Misuse Trends [abstract]Tringale M, Hinson M, Reilly S, Sirois J. NAADAC 2022 Conference. doi:10.13140/RG.2.2.12860.92800

    • Wu PE, Juurlink DN. Loperamide Cardiac Toxicity: Pathophysiology, Presentation, and Management. Can J Cardiol 2022;38:1378-1383. doi:10.1016/j.cjca.2022.04.005

    • Betting DJ, Chenoweth JA, Jarman AF. A Case Report of Cardiogenic Syncope Due to Loperamide Abuse: Acute Presentation and Novel Use of Buprenorphine. Clin Pract Cases Emerg Med 2021;5:214-217. doi:10.5811/cpcem.2021.3.51152

    • Daoub M, Cawley P, Sahu J. Loperamide-induced ventricular tachycardia storm. Br J Cardiol 2021;28:46. doi:10.5837/bjc.2021.046

    • De VJ, Kim HB, Sakr AE. A Case Report of Loperamide-Induced Ventricular Storm. J Investig Med High Impact Case Rep 2021;9. doi:10.1177/2324709621990768

    • Isang E, Shali L, Morris CB, Mahlow J. Loperamide-Induced Torsades de Pointes. Cureus 2021;13:e20299. doi:10.7759/cureus.20299

    • Khan N, Chitturi KR, Hatcher C, Clewing M, Nagueh SF. Loperamide Toxicity Revealing Apical Hypertrophic Cardiomyopathy. Methodist Debakey Cardiovasc J 2021;17:65-67. doi:10.14797/VRZW9460

    • Malinky CA, Lindsley CW, Han C. DARK Classics in Chemical Neuroscience: Loperamide. ACS Chem Neurosci 2021. doi:10.1021/acschemneuro.1c00382

    • Simon M, Rague J. A Case Report of Torsade de Pointes and Brugada Pattern Associated with Loperamide Misuse and Supratherapeutic Loperamide Concentrations. J Emerg Med 2021. doi:10.1016/j.jemermed.2021.04.016

    • Ali M, Mujahid A, Bulathsinghala CP, Surani S. Cardiac Arrhythmia Secondary to Loperamide Abuse and Toxicity. Cureus 2020;12:e6936. doi:10.7759/cureus.6936

    • Ali Z, Shoukat U, Khan M, Roomi S, Ullah W. ' Loperamide overdose induces ventricular tachycardia with catastrophic outcomes'. J Community Hosp Intern Med Perspect 2020;10:229-232. doi:10.1080/20009666.2020.1766839

    • Andersson L, Hakansson A, Krantz P, Johnson B. Investigating opioid-related fatalities in southern Sweden: contact with care-providing authorities and comparison of substances. Harm Reduct J 2020;17:5. doi:10.1186/s12954-019-0354-y

    • Atoot A, Sholem S, Khaddash I, Zuberi J . Transient Brugada Pattern Induced by Loperamide Abuse. Cureus 2020;12:e8037. doi:10.7759/cureus.8037

    • Brar JK, Broyan VR, Allgaier JT, Nye L, Saxon AJ. Long-term Buprenorphine Treatment for Loperamide Use Disorder: A Case Series. J Addict Med 2020;14:e378-e381. doi:10.1097/ADM.0000000000000687

    • Chiappini S, Schifano F. What about "Pharming"? Issues Regarding the Misuse of Prescription and Over-the-Counter Drugs. Brain Sci 2020;10. doi:10.3390/brainsci10100736

    • Donnelly SC. Recreational drug use of over-the-counter (OTC) medication: loperamide and the opiate epidemic. QJM 2020;113:1. doi:10.1093/qjmed/hcz315

    • Eggleston W, Palmer R, Dube PA et al. Loperamide toxicity: recommendations for patient monitoring and management. Clin Toxicol (Phila) 2020;58:355-359. doi:10.1080/15563650.2019.1681443

    • Escobedo Y, Wilson G, Costa SM, Ellington T. The long-lasting high: cardiac complications from loperamide toxicity. J Am Coll Cardiol 2020;75(11):2842.

    • Fayyaz S, et al. Loperamide abuse associated with cardiac dysrhythmia: case report [abstract] Eur J Emerg Med 2020;27:e12. doi:10.1097/01.mej.0000697860.10490.3d

    • Feldman R, Everton E. National assessment of pharmacist awareness of loperamide abuse and ability to restrict sale if abuse is suspected. J Am Pharm Assoc (2003) 2020;60:868-873. doi:10.1016/j.japh.2020.05.021

    • Fiil S, Kamronn TM, Petersen TS, Livbjerg S. [A young woman's loperamide abuse for the achievement of euphoric effect]. Ugeskr Laeger 2020;182.

    • Gaines H, Mao T, Murray C, Sivaram CA. The twisted truth: identifying and treating torsades de pointes (TDP) in surreptitious drug use. J Am Coll Cardiol 2020;75(11):2819.

    • Kapaganti S, Anwar AS, Saba R, Elkhouly A, Hassib M. A Rare Case of Loperamide-Induced Cardiac Arrest. Cureus 2020;12:e9396. doi:10.7759/cureus.9396

    • Leong J, et al. Loperamide Abuse: A Case Report and Brief Review. South J Pulm Crit Care 2020;20(2):73-75. doi:10.13175/swjpcc007-20 PDF

    • Lowe C, Latour C, Tanawuttiwat T. Torsades de pointes in substance abuse patient with negative urine toxicity. J Am Coll Cardiol 2020;75(11):2811.

    • Myllymaki L, Westerbergh J, Carlsson H, Hojer J. [Torsade de pointes following repeated massive loperamide ingestions]. Lakartidningen 2020;117.

    • Nair RM, Abdelghaffar B, Chung R. Loperamide Overdose With Ventricular Tachycardia Storm. Am J Ther 2020. doi:10.7759/cureus.3981

    • Rawala MS, Gulati R, Rizvi S. Cardiac Dysrhythmia Associated With Opioid Toxicity. Cureus 2020;12:e8243. doi:10.7759/cureus.8243

    • Rizzolo K, Best R, Erickson JE, Schaeffer T. Loperamide toxicity: a case report of turning bowels and twisting points. Journal of Maine Medical Center 2020;2(2):2. doi:10.46804/2641-2225.1046

    • Sahi N, Nguyen R, Santos C. Loperamide. Stat Pearls 2020.

    • Sahu KK, El MA, Mishra AK, Goyal S. A tale of twists: loperamide-induced torsades de pointes and ventricular tachycardia storm. BMJ Case Rep 2020;13. doi:10.1136/bcr-2019-232823

    • Sarker A, DeRoos A, Perrone J. Mining social media for prescription medication abuse monitoring: a review and proposal for a data-centric framework. J Am Med Inform Assoc 2020;27:315-329. doi:10.1093/jamia/ocz162

    • 2020. Terrie Y. Antidiarrheal Is Latest Candidate for Abuse. Pharmacy Times.

    • Watson JC, Whitledge JD, Barbuto AF, Boyle KL, Ganetsky M. Toxicity of agents used for opioid withdrawal: a case-based approach. Int Anesthesiol Clin 2020;58(2):19-27. doi:10.1097/AIA.0000000000000265

    • 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

    • Wolfes J, Ellermann C, Burde S et al. Divergent Electrophysiological Effects of Loperamide and Naloxone in a Sensitive Whole-Heart Model. Cardiovasc Toxicol 2020. doi:10.1007/s12012-020-09616-z

    • 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: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

    • 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

    • 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

    • 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

    • 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

    • 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

    • 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

    • 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