[ 06-07-2016 ] The U.S. Food and Drug Administration (FDA) is warning that taking higher than recommended doses of the common over-the-counter (OTC) and prescription diarrhea medicine loperamide (Imodium), including through abuse or misuse of the product, can cause serious heart problems that can lead to death. The risk of these serious heart problems, including abnormal heart rhythms, may also be increased when high doses of loperamide are taken with several kinds of medicines that interact with loperamide (see Examples of Drugs that Can Potentially Interact with Loperamide). 
 
 The majority of reported serious heart problems occurred in individuals who were intentionally misusing and abusing high doses of loperamide in attempts to self-treat opioid withdrawal symptoms or to achieve a feeling of euphoria. We continue to evaluate this safety issue and will determine if additional FDA actions are needed. 
 
 Health care professionals should be aware that use of higher than recommended doses of loperamide can result in serious cardiac adverse events. 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. If loperamide toxicity is suspected, promptly discontinue the drug and start necessary therapy. If loperamide ingestion is suspected, measure blood levels, which may require specific testing. For some cases of Torsades de Pointes in which drug treatment is ineffective, electrical pacing or cardioversion may be required. 
 
 Advise patients taking loperamide to follow the dosing recommendations on the label because taking higher than recommended doses, either intentionally or unintentionally, may lead to abnormal heart rhythms and serious cardiac events leading to death. Also advise patients that drug interactions with commonly used medicines also increase the risk of serious cardiac adverse events. Refer patients with opioid use disorders for treatment (see Additional Information for Health Care Professionals). 
 
 Patients and consumers should only take loperamide in the dose directed by their health care professionals or according to the OTC Drug Facts label. Do not use more than the dose prescribed or listed on the label, as doing so can cause severe heart rhythm problems or death. If your diarrhea lasts more than 2 days, stop taking loperamide and contact your health care professional. Seek medical attention immediately by calling 911 if you or someone taking loperamide experiences any of the following: 
 
 Fainting 
 
 Rapid heartbeat or irregular heart rhythm 
 
 Unresponsiveness, meaning that you can’t wake the person up or the person doesn’t answer or react normally 
 
 Ask a pharmacist or your health care professional if you are not sure how much loperamide to take, how often to take it, or whether a medicine you are taking may interact with loperamide. Always tell your health care professionals about all the medicines you are taking, including OTC medicines (see Examples of Drugs that Can Potentially Interact with Loperamide). 
 
 Loperamide is approved to help control symptoms of diarrhea, including Travelers’ Diarrhea. The maximum approved daily dose for adults is 8 mg per day for OTC use and 16 mg per day for prescription use. It is sold under the OTC brand name Imodium A-D, as store brands, and as generics. 
 
 In the 39 years from when loperamide was first approved in 1976 through 2015, FDA received reports* of 48 cases of serious heart problems associated with use of loperamide. This number includes only reports submitted to FDA, so there are likely additional cases about which we are unaware. Thirty-one of these cases resulted in hospitalizations, and 10 patients died. More than half of the 48 cases were reported after 2010. The serious heart problems occurred mostly in patients who were taking doses that were much higher than recommended. In other cases, patients were taking the recommended dose of loperamide, but they were also taking interacting medicines, causing an increase in loperamide levels. Additional cases of serious heart problems associated with the use of loperamide were reported in the medical literature.1-9 Cases reported to FDA and in the medical literature indicate that individuals are taking significantly high doses of loperamide in situations of both misuse and abuse, often attempting to achieve euphoria or self-treat opioid withdrawal. They are also combining loperamide with interacting drugs in attempts to increase these effects. 
 
 We urge patients, consumers, and health care professionals to report side effects involving loperamide or other medicines to the FDA MedWatch program, using the information in the “Contact FDA” box at the bottom of the page. 

 The Food and Drug Administration warned that people taking higher than recommended dosages of the diarrhea medication Imodium—often those who are intentionally abusing the medicine—run the risk of serious and even fatal heart problems. 
 
 The medicine, sold both over-the-counter and by prescription, goes by the generic name loperamide. Recent articles in emergency-medicine journals said that it is sometimes used by people looking for either self-treatment of opioid painkiller withdrawal, or to reach a euphoric state. 
 
 ... 

 Breaking News Emails Get breaking news alerts and special reports. The news and stories that matter, delivered weekday mornings. SUBSCRIBE 
 
 Too many people are overdosing on a diarrhea drug that has opiate-like effects, the U.S. Food and Drug Administration said Tuesday. 
 
 Many are accidental overdoses but people also report taking the drug, called Imodium, on purpose to help curb cravings for highly addictive opioid drugs. 
 
 Imodium walmart.com 
 
 Imodium, known generically as loperamide can cause deadly heart problems, the FDA said. 
 
 “The risk of these serious heart problems, including abnormal heart rhythms, may also be increased when high doses of loperamide are taken with several kinds of medicines that interact with loperamide,” the agency said in a statement. 
 
 High doses of the inexpensive and widely available medicine can make patients feel a high, said Dr. William Eggleston, a toxicologist at SUNY Upstate Medical Center, who helped write a report published in the Annals of Emergency Medicine about two men who died after abusing Imodium. 
 
 The researchers recommended tighter control on the drug. 
 
 “Action should be taken to regulate the sale of loperamide-containing products in a manner similar to pseudoephedrine, dextromethorphan, and other restricted over-the-counter medications,” they wrote. 
 
 “Additionally, steps should be taken to strengthen public awareness of the effects of loperamide abuse.” 
 
 Related: To Cut Opioid Abuse, Watch Doctors 
 
 FDA officials are thinking about it. 
 
 “The majority of reported serious heart problems occurred in individuals who were intentionally misusing and abusing high doses of loperamide in attempts to self-treat opioid withdrawal symptoms or to achieve a feeling of euphoria. We continue to evaluate this safety issue and will determine if additional FDA actions are needed,” the FDA said. 
 
 Imodium is sold both over the counter and by prescription to treat various causes of diarrhea, including traveler’s diarrhea. A well-known side effect of opiates and opioids is constipation. The drug acts in a similar way on the gut to slow things down. 
 
 The FDA recommended that people call 911 immediately if someone taking Imodium faints, has a fast or irregular heartbeat or cannot be woken up. 
 
 Related: CDC Has New Opioid Guidelines 
 
 “The maximum approved daily dose for adults is 8 mg per day for OTC use and 16 mg per day for prescription use. It is sold under the OTC brand name Imodium A-D, as store brands, and as generics,” the FDA said. 
 
 “In the 39 years from when loperamide was first approved in 1976 through 2015, FDA received reports of 48 cases of serious heart problems associated with use of loperamide. This number includes only reports submitted to FDA, so there are likely additional cases about which we are unaware.” 
 
 Ten of the people died, FDA said. Drugs that can interact badly with Imodium include some antibiotics and the antacid Tagamet.
– An increasing amount of Americans are taking the diarrhea medication Imodium to get high or cope with withdrawals from opioid painkillers. Now, the FDA is warning that the misuse of Imodium—generically known as loperamide—could cause serious, possibly fatal heart problems. Thanks to America's increasing addiction to opioids, the problem is getting worse. In the 39 years since loperamide was approved, the FDA got reports of 48 cases of serious heart problems—10 of them fatal—connected to the drug. More than half of those 48 cases came after 2010, and there are likely others that have gone unreported. Most of the problems have occurred in people who are intentionally abusing loperamide. The Wall Street Journal quotes a doctor who says loperamide is "extremely dangerous in high doses." It can cause "abnormally fast heart-rhythm disturbances," cardiac arrest, and fainting. Researchers want more regulation of loperamide sales, NBC News reports. And it's something the government is considering. “We continue to evaluate this safety issue and will determine if additional FDA actions are needed," the FDA states.