Consumers must be cautious in using common over-the-counter (OTC) and prescription diarrhea medication loperamide (Imodium). The U.S. Food and Drug Administration (FDA) has issued a warning that taking higher than recommended doses of the drugmay cause serious heart problems that may result in death.

The FDA’s warning is a result of the agency receiving 48 reports of serious health issues related to use of loperamide after 2010. The drug is better known by the brand name Imodium and is available as store brands and generics. The cases involve thirty-one resulting in hospitalization and ten in death. The FDA acknowledges that there are even more cases which have not yet entered the public eye.

Loperamide was approved to help control symptoms of diarrhea and has been on the market since the 1970s. It works by acting on opioid receptors in the stomach to slow the movement of the intestines, thus allowing the body to absorb essential fluids and nutrients normallyand restoring the consistency of stools. Loperamide’s maximum approved daily dosage for adults is eight (8) milligrams per day for OTC use and 16 milligrams per day for prescription use. However, a 2012 study of posts on online drug forums determined that people were taking daily doses of 70 to 100 milligrams of loperamide!

In the above cases serious heart problems,were reported when individuals were intentionally misusing high doses of loperamide to treat opioid withdrawal symptoms or to achieve a euphoric feeling. Because the active ingredient in loperamide is an opioid, the potential for abuse is enormous. This isonly exacerbated by the drug’s easy accessibility and inexpensive cost. As evidenced by the reports of poison control call centers, Loperamide abuse and misuse is growing across the country .

The risk of serious heart problems, including abnormal heart rhythms, increased when high doses of loperamide are taken with different types of medications. Drugs that pose interaction risks include:

  • Quinidine (heart drug);
  • Ritonavir (HIV drug);
  • Gemfibrozil (cholesterol drug);
  • Quinine (antimalarial drug);
  • Itraconazole and Ketoconazole (antifungal drugs);
  • Histamine type 2 Receptor Antagonists – H2RAs (anti-acid reflux drugs); and
  • Erythromycin and Clarithromycin (antibiotics).

The following are warning signs that an individual may be suffering from loperamide abuse or misuse:

  • Fainting;
  • Rapid heartbeat or irregular heart rhythm;
  • Unresponsiveness.