Imodium (loperamide) is an over-the-counter diarrhea medication that can be abused as an opioid. This can lead to a dependence on Imodium and overdose.

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Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in... read more
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Article at a Glance:

Imodium is an over-the-counter drug used to treat diarrhea.Some people abuse Imodium by taking high doses to get high or wean off opioids.Although Imodium is well-tolerated at recommended doses, high doses can cause serious side effects, including heart problems.

An Overview

It can be difficult for people to find easy access to opioid drugs. As a result, some people misuse substances like over-the-counter (OTC) products to either minimize withdrawal symptoms from opioids or achieve a euphoric sensation.

The intentional overuse of Imodium (the brand name of loperamide) has become an increasing safety concern. The Food and Drug Administration (FDA) has issued warnings regarding its misuse potential and the potentially fatal dangers of misuse. Understanding how Imodium works and the risks of misuse is crucial to preventing potentially fatal outcomes.

What Is Imodium?

Imodium is an over-the-counter medication that is available in a liquid, tablet, or capsule form. Its generic form, loperamide, is classified as an anti-diarrheal medication that helps manage non-infectious diarrhea, travelers’ diarrhea and inflammatory bowel disease. By prescription, it also helps reduce the amount of fluid in people with ileostomies. However, the drug can also be abused, leading the FDA to require packaging modifications in an attempt to reduce overdose risks.

Imodium Abuse

Imodium abuse is a direct result of the opioid epidemic. When taken at very high doses, the drug can create effects that are similar to opioids. Loperamide abuse has become so pervasive and problematic it is being dubbed the “poor man’s methadone.”

Since it is readily available and inexpensive, a person may take anywhere from 50 to 400 pills in a day to achieve a sense of euphoria similar to that of opioids. Unfortunately, doing so can lead to overdose.

Self-Medicating to Treat Opioid Withdrawal

Although opioid withdrawal symptoms can be treated with methadone and buprenorphine-based products, some people take high doses of loperamide as a way to self-medicate and avoid symptoms of opioid withdrawal. Rather than using loperamide to simulate an opioid high, a person may take loperamide as a way to treat a physical dependence on opioids. Unfortunately, using loperamide as a replacement for opioids requires very high doses of the drug, which can lead to overdose.

Related: Imodium (Loperamide) Overdose Risk, Symptoms, and Treatment

Imodium Abuse Risks

Loperamide can cross the blood-brain barrier, and when taken in high doses, it can activate opioid receptors in the brain. As such, there is a significant potential for loperamide abuse. Along with that abuse potential comes dangerous and sometimes deadly risks.

A loperamide overdose can cause:

Heart attackArrhythmiaDysfunction of the kidneys or liverSlowed or stopped breathingUrinary retentionIntestinal dysfunction

There have been dozens of reported heart problems associated with loperamide, and that number is likely to spike significantly as a result of loperamide abuse and addiction. Signs that someone is experiencing cardiac effects related to loperamide abuse include fainting, irregular or rapid heartbeat or unconsciousness.

FDA Intervention

As a result of widespread loperamide abuse in the United States, the FDA announced new restrictions on the drug’s packaging. As of 2019, each box of loperamide must have doses in individual blister packs and must not contain more than 48 mg total of loperamide.

Imodium Dependence and Addiction

Like other drugs that can cross the blood-brain barrier in high doses, loperamide may result in dependence. Physical dependence occurs when your body becomes used to the presence of a drug, leading to withdrawal symptoms if you suddenly stop taking it.

Further, addiction may be possible even though loperamide is not a controlled substance. Addiction occurs when a person keeps taking a substance even though it is causing negative consequences like financial hardships, strained relationships and mental or physical problems.

Ingredients in Imodium

The only active ingredient in Imodium is loperamide. Other brand names of loperamide include:

Imodium ADImotilKaopectate 1-DMaalox Anti-DiarrhealPepto Diarrhea Control.

Loperamide can also be found in combination with other OTC medications; for example, it is combined with simethicone in Imodium Multi-Symptom Relief. To see if loperamide is in a specific OTC product, review the active ingredients section on the label.

Loperamide should only be taken according to the approved dosage. The maximum daily dosage is 8 mg per day for OTC use and 16 mg per day for prescription use.

How Does Imodium Work?

Imodium (loperamide) acts by slowing the intestinal processes of digestion and affecting water and electrolyte movement through the bowel. It does so by binding to the opioid receptor in the gut wall, called the mu receptor. The activation of mu receptors in the digestive system causes a slowing of the digestive processes. This effect is what allows loperamide to control diarrhea; it also causes the common opioid side effect of constipation.

When taken at recommended and safe doses, loperamide does not cross the blood-brain barrier to affect mu receptors in the brain. These receptors are associated with the euphoric sensation caused by opioid substances. When taken at doses of around 50 mg a day, however, loperamide can reach brain mu receptors. There, it can produce euphoria and may lessen cravings and withdrawal symptoms of other substances.

Side effects of loperamide use may include:

ConstipationDrowsinessDizziness

The risk for serious side effects increases as the dosage of loperamide increases. The extremely high doses needed to cross the blood-brain barrier carry a significant risk for heart damage. Overdoses of loperamide ranging from four to 100 times the recommended dose have resulted in life-threatening cardiac reactions, including dangerous arrhythmias, cardiac arrest and death.

Severe side effects of loperamide that require immediate medical attention include:

NauseaVomitingAbdominal painUncomfortable feelings of fullness in the abdomenNoticeable changes in heartbeatFaintingDifficulty breathingFeverBloody stools

How Long Does Imodium Take To Work?

Loperamide reaches its highest concentrations in the blood, or its peak effect, five hours after ingestion for capsules and 2.5 hours after ingestion for liquid. This timeline is also true regarding symptoms of loperamide misuse, as the most severe symptoms are most likely to occur at the peak concentration of the medicine.

How Is Imodium Abuse Diagnosed?

Significant evidence links loperamide misuse to addiction. However, there is currently no specific screening tool to use in the diagnosis of loperamide misuse. Signs and symptoms indicating possible loperamide misuse coupled with a history of addiction are the only criteria that may help provide a diagnosis of loperamide abuse. When suspected, a specific blood test can be given to determine the concentrations of loperamide in the blood.

It is important for people struggling with loperamide misuse or addiction to receive help and guidance from trained professionals.

Imodium Addiction Statistics

Between 2010 and 2015, the National Poison Data System showed a 91% increase in reported intentional loperamide exposures. Data following the FDA’s new packaging requirements for loperamide is not yet available.

Regardless, given continued reports of loperamide abuse, it is crucial for caregivers and health care providers to remain vigilant for signs of loperamide misuse. This will allow someone to intervene during the early stages of addiction and prevent potentially fatal outcomes.

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Find the Help You Need

If you or someone you love struggles with loperamide misuse, it can be easy to lose hope. However, help is available at The Recovery Village. Contact us today to learn about loperamide addiction treatment programs that can work well for your situation.