Pharmacist Review of Loperamide Abuse

Loperamide is a common OTC antidiarrheal medication, also known as Imodium, that has been targeted as a drug of abuse by those seeking to relieve opioid withdrawal symptoms or achieve a euphoric high. Loperamide is a synthetic opioid agonist that lacks central nervous system effects when taken as directed. When taken at supratherapeutic doses, however, loperamide can cross the blood-brain barrier and lead to a variety of adverse effects, including cardiovascular-related complications. A concerning rise in overdose cases and fatalities associated with loperamide overdose has prompted the FDA to limit the amount of loperamide available in OTC packages. Pharmacists should be aware of the patterns of loperamide abuse and diversion and understand how to implement effective measures to prevent patient harm within their practice setting.