With increased barriers to the access of traditional substances of abuse, it is not uncommon to see the misuse of other substances, such as over-the-counter (OTC) products, to either minimize the withdrawal symptoms from other drugs or to achieve a euphoric sensation.

The intentional overuse of Imodium (the brand name of loperamide) has become an increasing safety concern and the Food and Drug Administration has recently issued warnings regarding the potential of its misuse and the dangers, including death, that are associated with its misuse. Understanding how Imodium works, and the risks involved in its misuse is crucial to providing intervention during the early stages of addiction and preventing potentially tragic outcomes.

What Is Imodium?

Imodium (loperamide) is a medication that is available with and without a prescription, that is used to help relieve diarrhea. Loperamide is classified as an anti-diarrheal medication and helps manage non-infectious diarrhea, travelers’ diarrhea, inflammatory bowel disease and, by prescription, to help reduce the amount of fluid in people with ileostomies. Imodium is widely accepted as effective and achieves its intended effect by slowing down the movement of the digestive system to decrease the number of bowel movements.

Ingredients in Imodium

The only active ingredient in Imodium, and therefore the only ingredient with potential for addiction, is loperamide. Other brand names of loperamide include Imodium AD, Imotil, Kaopectate 1-D, Maalox Anti-Diarrheal and Pepto Diarrhea Control.

Loperamide can also be found in combination with other OTC medications; for example, in Imodium Multi-Symptom Relief it is combined with simethicone. To find if loperamide is found in a specific OTC product, review the active ingredients section on the label of any OTC medication.

It is recommended that loperamide only be taken according to the approved dosage, with a maximum daily dosage of 8 mg per day for OTC use and 16 mg per day for prescription use. Loperamide is only recommended for use in patients two years of age and older.

How Does Imodium Work?

Imodium (loperamide) acts by slowing the intestinal processes of digestion and affecting water and electrolyte movement through the bowel by binding to the opioid receptor in the gut wall, which is called the mu receptor. The activation of mu receptors in the digestive system causes a slowing of the digestive processes. This effect results in the intended effect of loperamide to control diarrhea and the common side effect of opioids to cause constipation.

When taken at recommended and safe doses, loperamide does not cross the blood-brain barrier to affect mu receptors in the brain, which are associated with the euphoric sensation experienced with the use of opioid substances. However, when taken at very high and dangerous doses, loperamide has the potential to reach the mu receptors in the brain and can produce euphoria and may lessen cravings and withdrawal symptoms of other substances.

Side effects of loperamide use may include:

  • Constipation
  • Drowsiness
  • Dizziness

Severe side effects of loperamide that require immediate medical attention include:

  • Nausea
  • Vomiting
  • Abdominal pain
  • Uncomfortable feelings of fullness in the abdomen
  • Noticeable changes in heartbeat
  • Fainting
  • Difficulty breathing
  • Fever
  • Bloody stools

One of the most serious side effects of loperamide is a change in normal heart rhythm, called QT prolongation. The risk for serious side effects from loperamide increases as the dosage of loperamide increases. The extremely high doses needed to cross the blood-brain-barrier carry a significant risk for causing damage to the heart. Overdoses of loperamide ranging from four to 100 times the recommended dose have resulted in life-threatening cardiac adverse reactions, including dangerous arrhythmias, cardiac arrest, and death.

How Long Does Imodium Take to Work?

Imodium (loperamide) reaches its highest concentrations in the blood, and therefore peak effect, five hours after ingestion for capsules and two and a half hours after ingestion for the liquid. This timeline is also true regarding symptoms indicating misuse of Imodium, as the most severe symptoms are most likely to occur at the peak concentration of the medicine.

Common Imodium Nicknames and Street Names

Due to the increasing misuse of loperamide for the self-treatment of opioid withdrawal symptoms, Imodium (loperamide) has been given the nickname “poor man’s methadone.”

How Addictive Is Imodium?

Due to the potential of Imodium (loperamide) to affect the same receptors in the brain that are associated with the euphoria experienced with other opioid medications, it should be considered just as addictive as other opioids when it is taken in high doses.

Because large quantities are readily available through retail and internet outlets, misuse of Imodium is becoming more prevalent. Also, loperamide is not detected in routine urine drug screening for opioids. When considering the inherent addictive nature of the medication when taken at high doses, the accessibility, and availability of the product and the ability to evade detection on routine drug screenings, it is not surprising that many people — including teenagers and adults — abuse Imodium.

How Is Imodium Abuse Diagnosed?

Significant evidence links Imodium (loperamide) misuse to substance use disorder, however, there is currently no specific screening tool to use in the diagnosis of loperamide abuse.

Signs and symptoms indicating possible loperamide misuse coupled with a propensity for or history of substance use disorder are the only criteria that may help provide a diagnosis of loperamide abuse. When suspected, a specific blood test can be administered to determine the concentrations of loperamide in the blood.

It is crucial to provide compassionate education regarding the severity of the risks associated with the misuse of loperamide if it is suspected. It is important for people struggling with loperamide misuse or substance use disorder to receive help and guidance from trained professionals.

Imodium Addiction Statistics

Between 2010 and 2015, the National Poison Data System showed a 91% increase in reported intentional loperamide exposures. Considering the staggering statistics regarding the continued increase in the prevalence of substance use disorder, it is fair to conclude that the misuse of loperamide will continue to be of concern.

It is crucial for caregivers and health care providers to remain vigilant for signs of loperamide misuse to provide intervention during the early stages of addiction and prevent tragic, potentially fatal, outcomes.

If you or a loved one is struggling with drug or alcohol addiction, The Recovery Village can help. You can receive comprehensive treatment from one of our facilities located throughout the country. To learn more about our treatment programs, call The Recovery Village to speak with a representative today.  

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.