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Dangerous anti-diarrhea medicine: possible cardiac arrest due to loperamide


Misuse can lead to cardiac arrest in an emergency
High doses of the anti-diarrhea drug loperamide may appear to cause serious or even fatal heart problems. The American regulatory agency “Food and Drug Administration” (FDA) warns of this. According to the authority, consumers should therefore only take the drug within the limits of the approved dosage. The antidiarrheal loperamide is also available in pharmacies in Germany without a prescription. It is used for the symptomatic treatment of diarrheal diseases of various causes in adolescents and adults.

Active ingredient for the treatment of diarrhea
The active ingredient loperamide belongs to the group of so-called “peristaltic inhibitors” and is used in adolescents and adults to treat the symptoms of diarrhea. The maximum allowable daily allowance for adults in the United States is 8 mg per day for self-medication with over-the-counter medicines and 16 mg per day for prescription medications that are accepted on medical prescription.

Now the American regulatory authority FDA warns of misuse of loperamide, which is sold in the United States under the "Imodium® A-D" brand and in the form of own brands and generics. Because too high doses of the drug, according to a current message, serious heart problems are possible, which could even lead to death in an emergency. The same applies if high doses are combined with other drugs that interact with loperamide. Even then, the warning increases the risk of serious heart problems, which include abnormal heart rhythms.

Often combined with other drugs
The majority of the reported cases of severe heart problems have occurred in people who have misused high doses of loperamide, for example to treat the side effects of opioid withdrawal “or to achieve a feeling of euphoria,” reports the agency. In these cases of abuse, the active substance is often taken together with other substances which increase the absorption of the substance in the body (absorption) and lead to loperamide crossing the blood-brain barrier. Medicines that inhibit the breakdown of loperamide would also be used in parallel, thereby increasing the euphoric effects.

In the event of abnormalities, the intake must be stopped immediately
Medical professionals should be aware that the use of doses higher than the recommended dose of the product can lead to serious cardiac side effects. Accordingly, loperamide should be considered a possible cause of unexplained cardiac events including QT interval prolongation, torsade de pointes tachycardia or other ventricular arrhythmias (cardiac arrhythmia), syncope (cardiac failure) and cardiac arrest. If a toxic effect from loperamide is suspected, the drug must be discontinued immediately and appropriate therapy started, the FDA continues.

After two days of diarrhea, see a doctor
Patients suffering from diarrhea should on no account exceed the recommended maximum intake on the advice of the authority. If the liquid stool persists for more than two days, a doctor must be consulted. Caution should be exercised if patients pass out after taking loperamide, get a fast or irregular heartbeat, or no longer respond to a response or cannot be woken up. In these cases, the emergency doctor must be alerted immediately.

Large packs are subject to a prescription
Loperamide is also used in Germany to treat acute and chronic diarrhea. The two best-known drugs with the active ingredient are "Imodium acute" and "Loperamide ratiopharm acute". These are available in small packages with up to twelve tablets or capsules of two milligrams of active ingredient without a prescription from the pharmacy, as this corresponds to the maximum dose for two days. In addition to that, the freely accessible medicinal product must state that the product can only be used by adults and children from the age of 12, the “Deutsche Apotheker Zeitung” informs.

For children under two years taboo
For long-term treatment, the product is also available on prescription in the form of larger packs. The maximum dose for adults is 16 mg per day when prescribed by a doctor, just like in the USA. Under medical supervision, the drug can also be used from the age of two, the newspaper continues. The Federal Institute for Drugs and Medical Devices (BfArM) had pointed out a potential for abuse some time ago, since loperamide was apparently used in combination with quinine in the drug scene. This was one reason why quinine was subject to a prescription on January 1, 2015.

Do not take in case of fever or intestinal inflammation
The Chamber of Pharmacists of Lower Saxony recommends patients with diarrhea to get thorough advice in the pharmacy before self-medication with loperamide. Accordingly, the active ingredient should never be used if fever or blood occurs in the stool at the same time. The same applies to existing intestinal inflammation and diarrhea as a result of taking antibiotics. In these cases, as with persistent diarrhea (longer than two days), a doctor must be consulted. (No)

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