Loperamide dubbed ‘poor man’s methadone’ in misuse warning

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Diarrhoea remedy loperamide is being used to get a “morphine-like” high, according to the Daily Telegraph.

The Telegraph says use of the medicine, which it says has been dubbed the “poor man’s methadone” has grown in recent years in NSW and across Australia.

The Daily Telegraph has seen several web forum posts about loperamide abuse, some which include comments from people who say they’re from Australia,” reporter Ashleigh Gleeson wrote.

She quoted Australian National University Associate Professor Darren Roberts, a clinical toxicologist who said he’d heard of “very scattered cases” of loperamide being misused here.

“He said he thought the problem would be greater in small regional communities, where it might be harder to get codeine without raising suspicion,” she wrote.

“But he said he did not believe the issue was as big a problem is it is in the US, where codeine, a stronger opioid pain reliever, requires a prescription.”

Earlier this month the US Food and Drug Administration warned that taking higher than recommended doses of loperamide (Imodium), including through abuse or misuse of the product, can cause serious life-threatening arrhythmias that can lead to death.

“The risk of these serious life-threatening arrhythmias may also be increased when high doses of loperamide are taken with several kinds of medicines that interact with loperamide,” the FDA warned.

“Health care professionals should be aware that use of higher than recommended doses of loperamide can result in serious cardiac adverse events and consider loperamide as a possible cause of unexplained cardiac events including QT interval prolongation, Torsades de Pointes or other ventricular arrhythmias, syncope, and cardiac arrest.

“In cases of abuse, individuals often use other drugs together with loperamide in attempts to increase its absorption and penetration across the blood-brain barrier, inhibit loperamide metabolism, and enhance its euphoric effects.

“These drugs include cytochrome P450 3A4 (CYP3A4) inhibitors (e.g., itraconazole, clarithromycin), CYP2C8 inhibitors (e.g., gemfibrozil), and P-glycoprotein inhibitors (e.g., quinidine).”

The FDA says patients should be advised to take loperamide according to the dosing recommendations on the label since taking higher than recommended doses, either intentionally or unintentionally, may lead to abnormal heart rhythms and serious cardiac events that can lead to death. Patients with pre-existing cardiac conduction conditions may be at increased risk.

“Also, patients should be advised that drug interactions with commonly used medicines can also increase the risk of serious cardiac adverse events.”

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  1. Karalyn Huxhagen

    I have a customer who buys a box of 8 each week. Never been able to work out why as the answers she gives are non committal. she works as a bar maid and always looks like she needs a good sleep. will explore further what she is up to/

    • Poor girl

      “Up to”. If you read the piece from the Daily Telegraph cited in the article, they’re talking about the major groups of users as being either opioid dependent people using loperamide to manage withdrawal, or people with mental health issues taking up to 100 tablets at a time. I can think of about 20 reasons off the top of my head that a young woman might require ongoing loperamide, and abuse is extremely low on that list given the amounts she is buying and the description of the patient. I’m not surprised she doesn’t really want to delve into a discussion about her private medical history with you if you are approaching her with the attitude that’s she’s “up to” anything, rather than managing a condition that may be as benign as IBS or lactose intolerance, particularly when packs of up to 20 capsules are available as S2 products.

      • Karalyn Huxhagen

        as the sale is Pharmacy only I do ask her pertinent questions as I am required to. I do not push too hard as I agree that there can be many reasons why she is using it. She is such a regular purchaser that I do try to have a chat about the ‘why’. I am labelling her and I do not approach any of my customers with judgement. I work in an area of young people with such bad addictions to drugs such as Ice that I am careful with my language and approach.

  2. Really?

    My understanding was that the molecule was too large to penetrate the blood brain barrier. How does use of CYP inhibitors affect this? And seeing as all the items listed are prescription only, surely if you can convince your doctor to prescribe you ongoing quantities of clarithromycin or itraconazole (POOR man’s methadone?!) which would require objective clinical diagnoses you could convince them to prescribe you codeine for pain. This is bizarre and I honestly can’t think of a single patient over the past 5 years that buy massive amounts of loperamide without an explanation that can’t be derived from their dispensing history. This reeks of hysteria.

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