Loperamide Abuse Associated With Cardiac Dysrhythmia and Death

Ann Emerg Med. 2017 Jan;69(1):83-86. doi: 10.1016/j.annemergmed.2016.03.047. Epub 2016 Apr 29.


Loperamide is an over-the-counter antidiarrheal with μ-opioid agonist activity. Central nervous system opioid effects are not observed after therapeutic oral dosing because of poor bioavailability and minimal central nervous system penetration. However, central nervous system opioid effects do occur after supratherapeutic oral doses. Recently, oral loperamide abuse as an opioid substitute has been increasing among patients attempting to self-treat their opioid addiction. Ventricular dysrhythmias and prolongation of the QRS duration and QTc interval have been reported after oral loperamide abuse. We describe 2 fatalities in the setting of significantly elevated loperamide concentrations.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Arrhythmias, Cardiac / chemically induced*
  • Fatal Outcome
  • Humans
  • Loperamide / toxicity*
  • Male
  • Opioid-Related Disorders / drug therapy
  • Receptors, Opioid, mu / agonists
  • Self Care / adverse effects
  • Substance-Related Disorders / complications*
  • Substance-Related Disorders / diagnosis
  • Young Adult


  • Receptors, Opioid, mu
  • Loperamide