abusing diarrhea medicine, limit on loperamide

The opioid epidemic has spawned some improbable activity, such as people abusing diarrhea medicine. The FDA is cracking down on the over-the-counter pill loperamide. This drug, sold as Imodium A-D, has some opioid activity. That is why some people have been abusing it.

Is Loperamide a Dangerous Drug?

The agency says the drug is safe when used according to the instructions on the label. But if people swallow too many pills, the result could be irregular heart rhythms that could result in death. Between 2010 and 2016, at least 15 individuals nationwide died from loperamide overdose. In North Carolina alone, loperamide abuse caused or contributed to 19 deaths between 2012 and 2016 (Bishop-Freeman et al, Journal of Analytical Toxicology, Sep. 20, 2016).

How Can You Keep People from Abusing Diarrhea Medicine?

The FDA is not advocating that the drug be taken off the market. Instead, it has asked manufacturers to limit the number of doses sold in a standard package. Under the new guidelines, OTC dosage packs will be limited to 8 pills, enough to help control diarrhea for two days. If the diarrhea lasts for more than two days, the person should seek medical attention for it. The maker of Imodium A-D, Johnson & Johnson, has reportedly signaled its willingness to cooperate with the agency.

The FDA has also requested unit-dose packaging, in which each pill is encased in a plastic blister pack and must be individually unpeeled. Online drug distributors are also being asked to limit the amount of loperamide sold to a single individual at one time.

Side Effects of Loperamide:

When taken at normal doses, loperamide may cause drowsiness, dizziness, dry mouth and, of course, constipation. Those who are abusing diarrhea medicine are at risk for serious irregular heart rhythms and breathing difficulties. Interactions with other common drugs may make high-dose loperamide even more dangerous.

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  1. lilleth

    I think this proposal is absurd. I have noticed that both Costco and BJ’s Warehouse, both of which have sold loperamide in quantities of 92 per bottle or thereabouts in past, have recently removed it from their shelves/web sites. They are carrying nothing now. It seems the attack on people who need this medication has already begun.

  2. Kaye

    I have read the above comments very carefully and thoughtfully. And I know that there are people who intentionally abuse OTC drugs, which makes it difficult for regular drug users. I am 75 years of age and suffer from neither constipation, diarrhea, nor any other digestive disturbances. I am a firm believer that too many drugs, ingested into the body, will eventually cause liver disease, which can lead to death. In order for me to stay as “young” and as healthy as I am, the cost of drugs are not for me. That is why I use my “Fountain (Syringe) of Youth” in order to be drug-free and still stay healthy.

  3. A.M.

    Once again, drug abusers make it difficult for people who really need it.

  4. Carol

    If I have to limit my loperamide intake ( 1 per day), I would never be able to leave my house.

  5. Suzy

    Wait! Everyone’s jumping to conclusions. Loperamide makes withdrawal tolerable if you stop taking opioids. It doesn’t take very long, and then you have a chance to get off the heroin, etc. Loperamide does not cause any pleasurable sensations, although a gastroenterologist told me he had a patient once whom did get a buzz from it.
    I know from personal experience, btw.

  6. Sandra Lee B.

    For those who would prefer an herbal to an opioid , I would suggest they go to the health store and ask for some slippery elm bark. I never needed it myself but husband and one son had frequent diarrhea. Whenever that happened, they would come to me and ask for the slippery elm bark, One teaspoon is all you need in a little water and it is oh so inexpensive. I know of no side effects either.

  7. Wendy
    Matthews NC

    My son is a small bowel transplant recipient and has to have these daily. He takes 6 a day to slow things down, if not his food would go right through him. This medication is a necessity for him to survive….I had no idea about the irregular heartbeat issues, etc. This is scary.

  8. sura

    this is ridiculous. As an Irritable Bowel sufferer I need it often if I have to leave the house at certain times, and use on travel almost every day.

  9. LI

    Limiting loperamide sales to 8 tablets at a time will only make the drug more expensive. It will certainly also be an inconvenience to legitimate users. I fail to see why we have to keep accommodating people who abuse drugs. That is their bad decision; we should not have to pay for it.

  10. Donna L L

    My husband has an ileostomy due to ulcerative colitis/Crohn’s so he is prescribed loperimide. He can take up to 9 pills/day. Without it he would become dehydrated quickly because of the watery stool.

    • Bo


  11. Wendy
    Central Florida

    I take a non-insulin Diabetes 2 injectable medication and at times I suffer from multiple bowel movements and sometimes diarrhea. This medication does have its challenges. I have good days and some not so good days, but at times I take a Imodium tablet if only give me some confidence that I won’t be running back and forth to the bathroom. It does help tremendously. There has to be a better way to not penalize those who truly depend on this medication who are not abusers. .

  12. Lulu
    North Carolina

    When I travel to certain countries I need to bring more than two days worth of Immodium. Meanwhile abusers will find a way to get around the restrictions or find something else to abuse. I don’t think putting restrictions on every legal medicine that can possibly be abused will help the terrible epidemic, but it will make things more expensive and difficult for non abusers.

  13. Don
    Hopewell Jct, NY

    This is bad news for people with irritable bowel syndrome (diarrhea). I have controlled my symptoms for years with 1 immodium tablet per day. Without it, I need to be near a bathroom within 20 minutes of eating, and I need to stay seated for 10 to 20 minutes. Not fun. This was a cheap and easily available drug for IBS-D sufferers. I guess I need to stock up now before it becomes both expensive, and difficult to find.

    • Patti

      Zinc might help. I’ve had IBS D for way over 35 years and for almost 2 years I’ve been taking a probiotic for several months BC30 type but also Zinc glutanate and small amt copper separately & I think zinc helps! I recently saw a post where someone said it helped him.
      My hubby calls imodium d block off, doesn’t want me to take it. It is a life saver tho. This will just make the price go up. Just peachy….

  14. Laura

    I am familiar with many people who use this because they suffer from Bile Salts Malabsorption ~ some because they have lost their gall bladder. Without Imodium they would have to always be near a bathroom. It is a very difficult problem to deal with.

    • Barbara

      Laura, I had bile salts malabsorption and stopped it with one cheap calcium carbonate tablet a day, 600 mg. You don’t want to take a well absorbed calcium type or take magnesium with it. As an alternative a baby aspirin or NSAID stopped diarrhea for me, too, but I felt the calcium was safer. I went from 6 times a day to 1 or 2 times with the calcium carbonate. After about 5 years my body finally adjusted to the loss of my gallbladder and I no longer have to take anything for diarrhea.

  15. Anon

    I am my mother’s caregiver. She has both Alzheimer’s and chronic diarrhea. She has had bowel control issues for decades. She’s had colonoscopies that revealed nothing but a low “wink” reflex, every blood test known to man, diet changes, everything, to no avail.

    What finally worked? TWO loperamide tablets every single day, prescribed by her primary care physician. She has taken them for a couple of years now with great success and no side effects.

  16. reeter

    Is anyone besides me tired of being inconvenienced (at best) by people who abuse products then move on to something else if that product becomes inconvenient to get for them, too?

  17. Peggy

    This would be devastating for people with chronic diarrhea such as myself. I take loperamide two to three times per week, 4 to 6 tabs per day. My doctor is aware of this and it is really the only thing that helps me and I am definitely not getting high from it. I am very worried if these extreme limitations do occur.

  18. Cindy

    Coconut – in the form of macaroons or flakes really does work to stop the ‘runs’.

    • Linda

      I’ve tried macaroons and they have not helped with my diarrhea. I’m glad they help others, but they don’t help everyone.

    • Harlan

      I have collagenous colitis. Sorry, but coconut flakes (even the best organic flakes) don’t work for me. I agree with the other commenters: It’s time to stop catering to drug abusers by depriving legitimate users of drugs that can truly help when used responsibly.

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