Loperamide misuse and abuse

Objective: The epidemic of opioid prescription deaths in recent years resulted in the recent rescheduling of hydrocodone-containing products to restrict access to them. Opioid users have recognized that loperamide can ameliorate withdrawal symptoms and also produce euphoria in very high doses. This article discusses the potential for loperamide misuse and abuse and examines trends in the increasing number of published cases of loperamide toxicity. Design: PubMed was used to search MEDLINE for case reports of loperamide abuse. Setting: United States. Main outcome measures: Numbers of cases of loperamide misuse, characteristics of patients, reported toxicities. Results: From 1985 to 2016, 54 case reports of loperamide toxicity were published, with 21 cases between 1985 and 2013 and 33 cases between 2014 and 2016. In addition, 179 cases of intentional loperamide misuse were reported to the National Poison Database System between 2008 and 2016, with more than half reported after January 1, 2014. Conclusion: Loperamide misuse and abuse is increasing in the United States, and pharmacists are encouraged to monitor and restrict their sales. (C) 2017 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.