Increasing Reports of Loperamide Abuse.

[Argirios Argiriou]

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November 10, 2016

Increasing Reports of Loperamide Abuse

Daniel J. Pallin, MD, MPH reviewing Vakkalanka JP et al. Ann Emerg Med 2016 Nov 4.

Reports of abuse to poison control centers nearly doubled from 2010 to 2015.

Loperamide is a synthetic opioid available over the counter for treatment of diarrhea. It is rapidly metabolized and cleared from the cerebrospinal fluid at recommended doses, but at high doses may alleviate symptoms of opioid withdrawal or induce euphoria. Like any medication, it may also be used in suicide attempts. Investigators reviewed a national database of calls to poison control centers to determine whether calls for loperamide overdose increased from 2010 through 2015.

During the study period, there were 1736 reports of loperamide overdose. Half involved suicidal intent, and most of the remainder were intentional abuse or misuse. The number of cases increased 91% over the study period, equivalent to an average of 38 more cases per year. There were 15 deaths, 7 of which were reported to be after exposure to loperamide as a single agent. Death occurred in 0.8% of single-agent exposures and 0.9% of multiple co-ingestion exposures.

COMMENT

Loperamide causes the typical opioid toxidrome but is not detected on urine opioid screens. It can also cause QT prolongation and torsades de pointes. As we respond to the current opioid epidemic by complying with evidence-based guidelines and, simply, being more thoughtful when prescribing opioids, loperamide overdoses could rise. Loperamide ingestions therefore should be considered in the differential diagnosis for sedated overdose patients. Treatment for loperamide overdose is with naloxone to a target of adequate ventilation (not symptomatic withdrawal). Treatment for loperamide-related QT prolongation has not been established but logically would begin with intravenous magnesium. In addition, as with any other opioid, clinicians should consider the potential for abuse when recommending loperamide.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Daniel J. Pallin, MD, MPH at time of publication

Grant / Research supportNIH–National Center for Advancing Translational Sciences

Leadership positions in professional societiesSociety for Academic Emergency Medicine (Co-Chair, Scientific Subcommittee of Program Committee, 2015–2016; Chair, Program Committee, 2017–2018)

CITATION(S):

Vakkalanka JP et al. Epidemiologic trends in loperamide abuse and misuse. Ann Emerg Med 2016 Nov 4; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

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