Educating patients on the risks of misusing loperamide

Loperamide misuse and abuse is on the rise with some individuals consuming high doses in an attempt to self-manage their opioid withdrawal symptoms or achieve a euphoric high. The issue has become so pervasive problematic recent years that have labeled loperamide “poor man's methadone.” “Abuse of continues United States, taking higher than recommended can cause serious heart problems lead death,” said FDA news article when new packaging for OTC products was announced September 2019. changes Imodium A-D, Multi-Symptom Relief, Be Health HCl Capsules were intended address problem by limiting each carton no more 48 mg requiring unit-dose blister packaging. Pharmacists should be aware potential they educate patients safe effective use this medication. Consumer Healthcare Products Association (CHPA) entire webpage dedicated safety (www.loperamidesafety.org/). It includes numerous resources health care providers, including fact sheet pharmacists. Even though there are currently treatment protocols manage abuse, providers consider type patient presents unexplained cardiotoxicity (see sidebar). Since will not appear standard toxicology screen urine test detect its presence, encouraged ask specific questions, including▪Have you been using loperamide?▪How much do take how often?▪Are severe risks associated overuse, misuse, loperamide? Providers about appropriate dosing reviewing Drug Facts label product. CHPA notes cautious share information patients, however, since it important inadvertently inform someone who may at risk abuse. Educate report approved refer them source treatment, if possible. Also, exposures Poison Control FDA's MedWatch. potent µ-opioid receptor agonist sold treat diarrhea. When used as directed (i.e., maximum daily dose adults 8 per day 16 prescription use), product considered effective. However, supratherapeutic resulted increasing reports deaths. At doses, drug large margin, but excessive inhibit potassium channels cardiac sodium channels, which result QT QRS prolongation induce arrhythmias. reported users seeking opioid-like excess 100 dose. Fatal overdoses documented, such 5 from University South Carolina (J Forensic Sci. 2019;64(6):1726-30); 21 cases North Anal Toxicol. 2016;40(8):677-86); Alabama 2017;41(9):729-34). Most these white men thirties, most part mixed overdose. Signs toxicity▪Syncope fainting▪Rapid irregular heartbeat▪Unresponsiveness▪QT interval prolongation▪Torsades de pointes▪Ventricular arrhythmias▪Cardiac arrest▪GI complications (e.g., nausea, vomiting, constipation, paralyzed intestine)Source: www.loperamidesafety.org/resources ▪Syncope intestine) Source: