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Source: Thailand Medical News  Aug 19, 2019
Common Over The Counter (OTC) Diarrhea Drug, Loperamide Linked to Serious Cardiac Issues
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Common Over The Counter (OTC) Diarrhea Drug, Loperamide Linked to Serious Cardiac Issues
Source: Thailand Medical News  Aug 19, 2019
Loperamide, sold under the brand name Imodium, is a oral medication used to decrease the frequency of diarrhea. It is often used for this purpose in gastroenteritis and also in inflammatory bowel disease.


Loperamide or Immodium (In Thailand there are many generic versions
of it with various packagings and brands)


Unfortunately, the drug is not regulated and easily available at pharmacies without prescription in Thailand as it is classed as an OTC or over the counter drug. The drug has been on the market since the 1970s.

Despite previous studies in the past (since 2017, studies have emerged) that Loperamide is linked to serious cardiac events , nothing has been done to regulate the drug as many people with diarrhea will simply self-prescribe without seeing a doctor .

However of late there has been more cases of incidences and even fatalities occurring not only in Thailand but also globally.
Cardiac events including QT prolongation, torsades de pointes, and cardiac arrest have been reported in individuals who self prescribed with loperamide as a result of having diarrhea symptoms. These has been cases of fatalities also reported in individuals taking loperamide in doses that they should not have, due to lack of doing knowledge.

A European review of worldwide spontaneous reports identified  cases suggestive of cardiac rhythm disorders associated with loperamide use.

Individuals are warned, even with minute cases of diarrhea, do not attamept to self-medicate by visiting the drug store or pharmacies, instead make the efforst to visit a doctor, clinic or hospital to get the right diagnoses and the right medication and in the right doses according to your prevailing health conditions.

Medical Note For Doctors and Physicians

The European and US Medicines and Healthcare Products Regulatory Agencies have both  reminded healthcare professionals that the opioid antagonist naloxone can be given as an antidote in the event of loperamide overdose.

Since the duration of action of loperamide is longer than that of naloxone (1–3 hours), repeated continuous treatment with naloxone at intervals might be indicated. Patients should be monitored closely for at least 60 hours to detect possible CNS depression.

Taken in high doses loperamide, the drug may block potassium channels, leading to QT prolongation and arrhythmias. At extremely high concentrations, loperamide also has the potential to slow cardiac conduction via inhibition of sodium channels, and produce conduction arrhythmias which can be fatal.