Imodium Abuse Can Lead to Heart Problems and Death, FDA Warns

Federal drug regulators indicate that individuals face a risk of serious and potentially life-threatening heart problems from abuse of Imodium, which may occur when excessive amounts of the over-the-counter anti-diarrhea medication are taken. 

The FDA issued a drug safety advisory on Tuesday, warning that many people are experiencing serious heart problems after taking high doses of Imodium or taking Imodium in combination with other medications that interact with the drug.

The warning comes amid increasing concerns about Imodium abuse, following a number of poison control reports involving problems when individuals combined Immodium and the heartburn medication Prilosec to achieve a high. The Upstate New York Poison Center recently called for both medications to be removed from over-the-counter sales due to the risk of abuse.

In this new warning, the FDA indicates that Imodium A-D, known as generically as Loperamide, has the potential to cause serious heart complications that can even result in death of consumers who abuse or misuse of the product.

Risks include abnormal heart rhythms, serious cardiac events, QT interval prolongation, a disruption of the heart’s electrical cycle, Torsades de Pointes, an abnormal heart rhythm that can cause sudden cardiac death, syncope, cardiac arrest or other ventricular arrhythmias.

Federal health officials say the risk may be increased when high doses of Imodium are taken or doses are taken with several kinds of medicines that interact with Imodium. Medications that may interact with Imodium, include the antacid Tagamet HB, Zantac, some antibiotics, like clarithromycin, erythromycin, and ketoconazole.

“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,” the FDA press release warned.

Imodium was approved to help control symptoms of diarrhea, including travelers’ diarrhea, in 1976. The maximum approved dose for adults is 8 mg per day for OTC medications and 16 mg per day for prescription use.

Since being approved, the FDA received 48 reports of serious heart problems associated with Imodium. The agency says this number is likely an under representation considering it only includes reports submitted to the FDA. It is likely there are additional cases of which the agency is unaware.

Of the 48 cases, more than half were reported after 2010 and 31 of the cases resulted in hospitalization and 10 patients died.

The FDA warns health care professionals should also be aware that using higher doses than recommended can result in serious cardiac adverse events.

In many cases of abuse, individuals will use other drugs or medications, like Imodium, to increase absorption and penetration across the blood-brain barrier for other drugs, or take higher doses to reduce Imodium from metabolizing to enhance its euphoric effects.

The agency warns that individuals experiencing heart problems after taking Imodium should, immediately stop use of the drug and call a health care professional. If diarrhea lasts more than two days, stop taking Imodium and contact a doctor or call  911 if you or the person taking the medication experience fainting, rapid heartbeat, irregular heart rhythm, or if the person is unresponsive or not reacting normally.

Patients should always follow dosing recommendations listed on the package and always tell a doctor about all the medications they are taking, including OTC medications.