[Loperamide abuse - constipation or heart attack?]

Area of Science:

• Pharmacology
• Toxicology
• Public Health

Background:

• Loperamide, a μ-opioid receptor agonist, is used for antidiarrhoeal effects.
• It is generally considered to have low abuse potential due to metabolism and blood-brain barrier efflux.
• However, high doses can cause central nervous system effects and life-threatening cardiac dysrhythmias.

Purpose of the Study:

• To investigate potential loperamide misuse in Iceland between 2006 and 2017.
• To analyze prescription data for excessive loperamide usage patterns.

Main Methods:

• Retrospective analysis of prescription drug database records from The Directorate of Health in Iceland.
• Examination of loperamide prescription data from 2006-2017.

Main Results:

• Analysis revealed 94 individuals used more than one Defined Daily Dose (DDD) of loperamide (10 mg/day).
• Seventeen individuals used more than two DDDs (20 mg/day) daily over a year.
• These findings suggest excessive loperamide use, though reasons and over-the-counter sales remain unquantified.

Conclusions:

• Loperamide is being used excessively in Iceland, indicating potential misuse.
• Increased surveillance and reduced availability of prescription opioids may contribute to this trend.
• Healthcare professionals must be informed about the severe adverse effects of loperamide overdose, including cardiac dysrhythmias.