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Chronic use of loperamide, an antidiarrhoeal drug, can cause serious adrenal insufficiency. This case highlights the importance of monitoring endocrine function in patients with inflammatory bowel disease using high-dose loperamide.

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Area of Science:

  • Endocrinology
  • Pharmacology
  • Gastroenterology

Background:

  • Loperamide is a widely used antidiarrhoeal medication.
  • Chronic use can lead to adverse effects, particularly in patients with inflammatory bowel disease.
  • Adrenal insufficiency is a serious, potentially life-threatening endocrine disorder.

Purpose of the Study:

  • To report a previously undocumented adverse effect of chronic loperamide use.
  • To investigate the link between high-dose loperamide and adrenal insufficiency.
  • To emphasize the need for clinical caution in managing chronic diarrhoea with loperamide.

Main Methods:

  • Case report of a 45-year-old male with inflammatory bowel disease.
  • Biochemical assessment including hormone levels and Short Synacthen Test (SST).
  • Monitoring of endocrine function in relation to loperamide dosage adjustments.

Main Results:

  • The patient presented with hypogonadism and adrenal insufficiency.
  • Loperamide dose reduction led to a normal SST response.
  • Increased loperamide dosage correlated with a subnormal SST response.
  • Chronic high-dose loperamide use was implicated in drug-induced adrenal insufficiency.

Conclusions:

  • Clinicians should be cautious when prescribing loperamide for chronic diarrhoea.
  • Monitoring for adrenal insufficiency is crucial in patients on long-term, high-dose loperamide.
  • Drug-induced adrenal insufficiency is a significant risk associated with loperamide misuse.