Imodium is the most common brand name for the generic drug loperamide, a medicine used to treat diarrhea. The medication binds to opioid receptors in the gut wall. This triggers the digestive system to slow the movement of food through the gastrointestinal tract and also increases the tone of the sphincter. These, which increases the firmness, and decreases the number, of bowel movements, so the person taking Imodium receives some relief.

When loperamide was first under clinical investigation, the Drug Enforcement Agency placed the medication on the Controlled Substances list under Schedule II – the same place where addictive but medically beneficial medications, like oxycodone and hydrocodone, reside today. In 1976, the Drug Enforcement Agency placed loperamide on the Controlled Substances list as Schedule V, indicating that the substance had a low potential for abuse. Loperamide has a low ability to cross the blood-brain barrier, only producing analgesic effects in extremely high doses. In 1982, it was removed from the Controlled Substances list, and it was later approved for over-the-counter use.

However, there are reports of intentional abuse of Imodium. In extremely high doses, the substance can potentially cause a mild high and reduce opioid withdrawal symptoms, since it binds to opioid receptors.

Imodium Abuse

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Who Is at Risk for Imodium Abuse?

People who struggle with addiction to opioid drugs, from Percocet to heroin, are at risk of abusing Imodium. These individuals primarily begin taking Imodium to ease symptoms of narcotic withdrawal. Opioid drugs lead to constipation, so one common withdrawal symptom when a person begins to detox from opioids is diarrhea.

Imodium binds to opioid receptors in the gut, slowing down the digestive system’s movements and increasing sphincter tone, thereby reducing or stopping diarrhea.

Withdrawing from narcotics is not typically dangerous, although no one should undergo this process without the oversight of a medical professional. Doctors can help with tapering people off the drugs, prescribing medications to ease withdrawal, and overseeing the process to ensure safety throughout withdrawal. People who attempt to withdraw from opioid drugs alone put themselves at risk of relapsing, which can lead to overdose.

People who use Imodium to detox from opioid addiction often end up abusing Imodium instead. In addition, those who attempt to detox on their own often relapse to the original opioid abuse, and they are then at increased risk of overdose due to their decreased tolerance.

How Does Imodium Abuse Start?

There have been very few issues with Imodium abuse until the opioid epidemic in the US developed. In 2016, there were 32,445 deaths involving prescription opioids, according to the Centers for Disease Control, which amounts to an average of almost 89 deaths per day. That number increased from 22,598 deaths in 2015. Even with increasing federal and state controls around opioid prescriptions, heroin is a relatively cheap illicit drug in the US, and many people who can no longer access prescription painkillers may turn to heroin. Since loperamide binds to opioid receptors, people who struggle with addiction to opioids are at a higher risk of abusing this substance too.

A report published in the Annals of Emergency Medicine stated that there was a tenfold increase in online forum posts between 2010 and 2011 discussing abuse of Imodium. Researchers reported that about 70 percent of the posts talked about Imodium as a home remedy to alleviate opioid withdrawal symptoms. However, around 25 percent of posts discussed abusing Imodium to get high. Between 2011 and 2014, there was a 71 percent increase in the number of calls to US poison control centers involving loperamide abuse or misuse.

The maximum daily dose of Imodium is 16 mg per day, and the over-the-counter drug facts label on the package advises users that, if the individual’s diarrhea lasts more than a couple days, they should see a medical professional. However, an overview of almost 1,300 online posts in 2012 showed individuals were taking 70-100 mg  of Imodium. Those doses are large enough to cause severe side effects and even death.

How Does Imodium Abuse Start?

Symptoms of Imodium Abuse

Side effects of Imodium include:

  • Constipation
  • Fainting
  • Stomach pain or bloating
  • Dizziness
  • Nausea
  • Urinary retention
  • Drowsiness
  • Skin itching or rash
  • Rapid and/or irregular heartbeat

These side effects are more likely at higher doses, so individuals who abuse Imodium are more likely to suffer from them. Because the dose required to get high is such a large amount of the medication, overdose symptoms can occur at any time in individuals abusing the drug.

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Overdose from Imodium

Overdose signs and consequences include:

  • Nausea and vomiting
  • Liver problems
  • Slowed breathing
  • Stopped intestine, leading to blockage
  • Urinary retention
  • Irregular heartbeat
  • Slowed pulse
  • Heart attack
  • Death

Some of the most dangerous potential side effects of Imodium overdose are arrhythmias, loss of consciousness, and even cardiac arrest. Since loperamide was approved by the FDA in 1976, 48 instances of serious heart problems associated with loperamide had been reported to the FDA by 2015. However, over half of those instances occurred between 2010 and 2015, likely due to a rise of recreational Imodium abuse. The problem has become so concerning that the FDA has issued a warning regarding the potential for excessive Imodium use to cause cardiac arrhythmias, which can be deadly.

Immediately call 911 if these or other concerning symptoms appear after taking loperamide:

  • Fainting
  • Fast heartbeat
  • Irregular heartbeat
  • Inability to wake the individual up or the individual not reacting normally

Imodium Withdrawal Symptoms and Treatment Options

Because Imodium binds to opioid receptors, people who abuse this substance may experience withdrawal effects similar to those of other opioids. Opioid withdrawal symptoms might include:

  • Diarrhea
  • Stomach cramps
  • Nausea and vomiting
  • Agitation
  • Anxiety
  • Cold or flu-like symptoms such as runny nose, muscle aches, goosebumps, and watery eyes
  • Excessive yawning
  • Sweating
  • Insomnia
  • Dilated pupils

People who have already stopped abusing opioid drugs like heroin or oxycodone may be more likely to suffer withdrawal symptoms if they also stop abusing Imodium, because their bodies are already reacting to the absence of opioids. It is important to get help from a medical professional and a rehabilitation program when trying to overcome any addiction, whether it is to heroin, Imodium, alcohol, or any other substance. A medical professional can create a tapering plan to ease the body off of opioids, and that professional can prescribe other medications to ease some withdrawal symptoms. These treatments can reduce the risk of relapse.

Because Imodium can be so physically dangerous in large doses, it is extremely important to get help to detox from this substance as soon as possible. Detox alone, however, is rarely enough to overcome an addiction and maintain long-term recovery. It is important to find a rehabilitation program that will address the addiction with treatment after detox.
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