Dangerous anti-diarrheal medicine Possible cardiac arrest due to loperamide

Misuse can lead to cardiac arrest in case of emergency
High doses of the anti-diarrheal drug loperamide can evidently cause serious or even fatal cardiac problems. The US Food and Drug Administration (FDA) is warning against this. According to the authority, consumers should therefore only take the drug within the permitted dosage. The Antidiarrhoikum Loperamide is also available over the counter in the pharmacy in Germany. It is used for the symptomatic treatment of diarrheal diseases of various causes in adolescents and adults.

Active ingredient for the treatment of diarrheal diseases
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 daily allowable dose for adults in the United States is 8 mg per day self-medication with over-the-counter medicines and 16 mg per day for prescription drugs taken on prescription.

The US regulator warns against the misuse of anti-diarrheal drugs. (Image: denisismagilov / fotolia.com)

Now, the US Food and Drug Administration (FDA) is warning of misuse of loperamide, which is sold in the US under the Imodium® A-D brand, as well as private label and generics. Because too high dosages of the drug are according to a recent release, serious heart problems possible, which could even lead to death in an emergency. The same is true when high doses are taken in combination with other medicines that interact with loperamide. Even then, the alert increases the risk of serious heart problems, including cardiac arrhythmias.

Common combination with other medications
The majority of reported cases of severe heart problems occurred in people who had ingested excessively high doses of loperamide, for example, to treat the side effects of opioid withdrawal themselves or "to achieve a sense of euphoria," reports the agency. The drug in these cases of abuse is often taken together with other substances that increase the absorption of the substance into the body (absorption) and cause loperamide to cross the blood-brain barrier. Likewise, drugs would be used in parallel to inhibit the breakdown of loperamide, thereby increasing the euphoric effects.

In case of abnormalities, the intake must be stopped immediately
Medical professionals should be aware that using higher than recommended doses of the drug can cause serious cardiac side effects. Accordingly, loperamide should be considered as a possible cause of unexplained cardiac events including prolongation of QT interval, torsade de pointes tachycardia or other ventricular arrhythmias, syncope and cardiac arrest. If loperamide is suspected to have toxic effects, the drug should be discontinued immediately and treatment should commence, the FDA said.

After two days diarrhea to the doctor
Patients suffering from diarrhea should never exceed the recommended maximum intake on the authority's advice. If the fluid defecation persists for more than two days, a doctor must be consulted. Caution should be taken when patients faint after taking loperamide, get a rapid or irregular heartbeat or no longer respond to response or can not wake up. In these cases, the emergency doctor should be alerted immediately.

Large packs are subject to prescription
Loperamide is also used in Germany for the treatment of acute and chronic diarrhea. The two most well-known drugs with the active substance are "Imodium acute" and "Loperamid-ratiopharm acute". These are available in small packages with up to twelve tablets or capsules à two milligrams of active ingredient without prescription in the pharmacy, as this corresponds to the maximum dose for two days. In addition, it must be noted on the freely available funds, the note that the remedy may only be taken by adults and children from the age of 12 years, informed the "Deutsche Apotheker Zeitung".

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

No use for fever or intestinal inflammation
The Apothekerkammer Niedersachsen recommends patients with diarrhea to be given thorough advice before self-medication with loperamide in the pharmacy. Accordingly, the drug should not be used if parallel fever or blood in the stool occurs. The same applies to existing intestinal inflammation and diarrhea as a result of taking antibiotics. In these cases, just as with persistent diarrhea (longer than two days) must necessarily consult a doctor. (No)