# Potential problems from chronic use of extremely high dosage of loperamide HCL (imodium)? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [November 3, 2012, 1:34am UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724 "2012-11-03T01:34:01Z")\ **Posts on this page:** 19\ **Page:** 1
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [November 3, 2012, 1:34am UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/1 "2012-11-03T01:34:01Z")
This is something that has been on my mind for quite some time. I suffer from certain spinal-cord injury-related gastro-intestinal issues which have plagued me for the duration of my time as a paraplegic (12+years). Over this time I have seen myriad doctors and have been given myriad diagnoses (lack of fiber, irritable bowel syndrome, food sensitivities, etc.) yet I have experienced NOTHING in the way of relief from this _ferociously_ embarrassing and agonizingly frustrating problem of sudden and intractable diarrhea. Over this time, I have learned-out of sheer determination never to let what had happened to me several times in the past happen to me again-one surefire way of controlling this menacing problem; _huge_, daily doses of Imodium A-D (loperamide HCL) as a prophylactic treatment. And when I say “huge” I really mean it. According to the bottle, the maximum daily dosage of this medication is 4 capsules in 24 hours. I will regularly take four or even five times that amount in one day. Now I know this is not a great idea but I honestly have NO other option. When you’ve shit yourself totally unexpectedly in a few public places-one even when you were on a date-as well as a number of other humiliating experiences, you quickly become adamant as a functioning adult that such occurrences are absolutely not acceptable. What my question is is what are the potential problems from such a habit? This has been going on for a number of years now; probably about 5 or so consistently. I haven’t noticed any ill-effects at this point but I’d like to know what I might be doing to myself. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [November 3, 2012, 1:55am UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/2 "2012-11-03T01:55:13Z")
In high enough doses, for a long enough time, or taken with many common drugs (or even enough black pepper) it acts like an opioid, crossing the blood brain barrier. Central nervous system depression, including slowing your breathing and heart rate, as well as physical addiction to the drug and needing increasingly large doses to be effective are potential problems. Given your health conditions, it’s worth a conversation with your doctor to determine if these risks are outweighed by the obvious benefits, or if something else should be tried instead. ---
**Author:** ![Harmonix](https://avatars.discourse-cdn.com/v4/letter/h/3ec8ea/32.png) [@Harmonix](https://boards.straightdope.com/u/Harmonix)\ **Post date:** [November 3, 2012, 2:01am UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/3 "2012-11-03T02:01:11Z")
IANAD, IANAP, IAMA biology graduate student with some knowledge of physiology. Excuse the phrase, but i’ll be talking out of my ass from here on out. Reading the wikipedia page for Loperamide > **[Loperamide](https://en.wikipedia.org/wiki/Loperamide)** > > Loperamide, sold under the brand name Imodium, among others, is a medication of the opioid receptor agonist class used to decrease the frequency of diarrhea. It is often used for this purpose in irritable bowel syndrome, inflammatory bowel disease, short bowel syndrome, Crohn's disease, and ulcerative colitis. It is not recommended for those with blood in the stool, mucus in the stool, or fevers. The medication is taken by mouth. > Common side effects include abdominal pain, constipation, sleep... I note a few passages which may be of interest. > [@](#): > > It works by decreasing the activity of the myenteric plexus, which, like morphine, decreases the tone of the longitudinal smooth muscles but increases the tone of circular smooth muscles of the intestinal wall. This increases the amount of time substances stay in the intestine, allowing for more water to be absorbed out of the fecal matter. Loperamide also decreases colonic mass movements and suppresses the gastrocolic reflex.[5] Loperamide appears to work by inhibiting nerves in the gut. Specifically those that control smooth muscle. I imagine that very high doses might also effect your esophagus and you might have trouble swallowing. I also suspect that if you’re taking very high daily doses that these nerves might acclimate to the inhibitor such that when you come off it they may become hyper active. Meaning if you stop, you might get the shits even more. > [@](#): > > Concurrent administration of P-glycoprotein inhibitors such as quinidine and its other isomer quinine (although much higher doses must be used), PPIs like omeprazole (Prilosec OTC) and \*\*even black pepper (piperine as the active ingredient) \*\* could potentially allow loperamide to cross the blood–brain barrier. It should however be noted that only quinidine with loperamide was found to produce respiratory depression, indicative of central opioid action.[6] Maybe lay off the Black pepper? because of the following. > [@](#): > > Only when very high doses are taken does enough accumulate in the brain to produce typical opioid effects, lasting for a number of hours (just as typical opioids would).[8][9] and > [@](#): > > However, loperamide has been shown to cause a mild physical dependence during preclinical studies, specifically in mice, rats, and rhesus monkeys. Symptoms of mild opiate withdrawal have been observed following abrupt discontinuation of long-term therapy with loperamide.[10][11] So it seems that loperamide circulates and generally only effects the PNS because it’s blocked by the Blood Brain Barrier and ion pumps in the CNS. If you take too high a dose some gets through and might act like a typical opiod would. Read: it may be mildly addictive and I suspect you may have withdrawal symptoms. again, IANAD, IANAP ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [November 3, 2012, 2:01am UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/4 "2012-11-03T02:01:52Z")
> [@WhyNot](#): > > Given your health conditions, it’s worth a conversation with your doctor to determine if these risks are outweighed by the obvious benefits, or if something else should be tried instead. Oh I have discussed this. I’ve _tried_ pretty much all there is to try. ---
**Author:** ![Senegoid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/senegoid/32/6606_2.png) [@Senegoid](https://boards.straightdope.com/u/Senegoid)\ **Post date:** [November 3, 2012, 2:03am UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/5 "2012-11-03T02:03:42Z")
Ack! This gives _new meaning_ to your many past threads in which you complain of inaccessible bathrooms! I myself once suggested (about a year ago or so?) that you should protest by dropping your pants right there in front of everybody when you need to go, and leave it to _everyone else_ (proprietors of the establishment in particular) to be embarrassed or humiliated. But I didn’t really have this in mind :eek: ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [November 3, 2012, 2:04am UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/6 "2012-11-03T02:04:50Z")
> [@Harmonix](#): > > IANAD, IANAP, IAMA biology graduate student with some knowledge of physiology. > > Loperamide appears to work by inhibiting nerves in the gut. Specifically those that control smooth muscle. I imagine that very high doses might also effect your esophagus and you might have trouble swallowing. I also suspect that if you’re taking very high daily doses that these nerves might acclimate to the inhibitor such that when you come off it they may become hyper active. Meaning if you stop, you might get the shits even more. Hmm, this could be at play here. For sure. Also, I do take Prilosec everyday as well. ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [November 3, 2012, 2:07am UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/7 "2012-11-03T02:07:30Z")
> [@Senegoid](#): > > Ack! This gives _new meaning_ to your many past threads in which you complain of inaccessible bathrooms! Yeah, I’ve shit myself while I’ve stared desperately at rows of empty yet inaccessible toilets more than once. All because the person who went into the handicap stall before me “didn’t see any handicap person around when they went to use it”. ---
**Author:** ![Harmonix](https://avatars.discourse-cdn.com/v4/letter/h/3ec8ea/32.png) [@Harmonix](https://boards.straightdope.com/u/Harmonix)\ **Post date:** [November 3, 2012, 2:09am UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/8 "2012-11-03T02:09:55Z")
Logic tells me lack of movement in the gastrointestinal system might lead to the acid staying in your stomach/gut too long hence leading to the gastroacidic reflux. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [November 3, 2012, 2:10am UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/9 "2012-11-03T02:10:55Z")
> [@Ambivalid](#): > > Oh I have discussed this. I’ve _tried_ pretty much all there is to try. Ugh. I’m sure. And there really just isn’t all that much to try, sadly. It pretty much all comes with the same dangerous long term side effects. Seems like the gut should be a pretty easy, mechanical thing to fix, and it just isn’t. My SO went though the gamut after his ileostomy (from loperimide to lomotil to dilaudid)…and it’s a pretty short gamut. Sucks. ---
**Author:** ![Lasciel](https://avatars.discourse-cdn.com/v4/letter/l/e79b87/32.png) [@Lasciel](https://boards.straightdope.com/u/Lasciel)\ **Post date:** [November 3, 2012, 2:14am UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/10 "2012-11-03T02:14:16Z")
I know this is going to sound like a facile suggestion, and I only mention it because I have a relative with bowel-control problems, but adult diapers truly don’t seem to be that awful. I know regular ones are a PITA even in the privacy of a home bathroom, but there seem to be a few flushable ones on the market. I bet you could manage that with not much more difficulty than a normal bathroom break. ---
**Author:** ![Colibri](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/colibri/32/1841_2.png) [@Colibri](https://boards.straightdope.com/u/Colibri)\ **Post date:** [November 3, 2012, 2:17am UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/11 "2012-11-03T02:17:07Z")
Medical advice is best suited to IMHO. Colibri General Questions Moderator ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [November 3, 2012, 2:37am UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/12 "2012-11-03T02:37:48Z")
> [@Lasciel](#): > > I know this is going to sound like a facile suggestion, and I only mention it because I have a relative with bowel-control problems, but adult diapers truly don’t seem to be that awful. > > I know regular ones are a PITA even in the privacy of a home bathroom, but there seem to be a few flushable ones on the market. I bet you could manage that with not much more difficulty than a normal bathroom break. Yeah I would rather continue with the imodium. ---
**Author:** ![davidm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidm/32/225_2.png) [@davidm](https://boards.straightdope.com/u/davidm)\ **Post date:** [November 3, 2012, 2:51am UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/13 "2012-11-03T02:51:12Z")
I have a similar problem, though not for the same reasons as you. Imodium doesn’t work for me and neither does Lomotil. What has worked is an injectable medication, Octreotide. The brand name is Sandostatin but I take the generic. I inject it with an insulin syringe. I am not in any way a medical professional and I have no idea if it would be appropriate for you or not, but you may want to ask your doctor about it. ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [November 3, 2012, 3:01am UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/14 "2012-11-03T03:01:23Z")
> [@davidm](#): > > I have a similar problem, though not for the same reasons as you. Imodium doesn’t work for me and neither does Lomotil. > > What has worked is an injectable medication, Octreotide. The brand name is Sandostatin but I take the generic. I inject it with an insulin syringe. I am not in any way a medical professional and I have no idea if it would be appropriate for you or not, but you may want to ask your doctor about it. Thanks! I will! ---
**Author:** ![davidm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/davidm/32/225_2.png) [@davidm](https://boards.straightdope.com/u/davidm)\ **Post date:** [November 3, 2012, 3:35am UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/15 "2012-11-03T03:35:23Z")
It’s not a standard medication. Drugstores don’t carry it and it has to be special ordered, so your GP may not be familiar with it. A gastroenterologist would probably be familiar with it. ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [November 3, 2012, 4:12am UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/16 "2012-11-03T04:12:37Z")
> [@Lasciel](#): > > I know this is going to sound like a facile suggestion, and I only mention it because I have a relative with bowel-control problems, but adult diapers truly don’t seem to be that awful. > > I know regular ones are a PITA even in the privacy of a home bathroom, but there seem to be a few flushable ones on the market. I bet you could manage that with not much more difficulty than a normal bathroom break. A BIG issue related to uncontrollable diarrhea afflicting those who don’t have use of their legs that such a solution (adult diapers) wouldn’t really address is getting the soiled clothing/diaper off after the ‘deed has been done’ _without_ further smearing yourself, your clothing and/or your wheelchair cushion with liquid shit. Removal of such pieces would involve a lot of _yanking_, _tugging_ and _bouncing_; especially if being done in the awkward quarters of a public restroom stall. ---
**Author:** ![Bumbazine](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bumbazine/32/362_2.png) [@Bumbazine](https://boards.straightdope.com/u/Bumbazine)\ **Post date:** [November 3, 2012, 8:54pm UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/17 "2012-11-03T20:54:40Z")
> [@Ambivalid](#): > > Hmm, this could be at play here. For sure. Also, I do take Prilosec everyday as well. I took Prilosec for a while and it gave me horrible diarrhea, it may be exacerbating your problem. I’m taking something called Ranitidine HCL now, IIRC, which doesn’t bother my gut and has the added benefit of being quite a bit cheaper as well. ---
**Author:** ![perfectparanoia](https://avatars.discourse-cdn.com/v4/letter/p/a5b964/32.png) [@perfectparanoia](https://boards.straightdope.com/u/perfectparanoia)\ **Post date:** [November 5, 2012, 5:06pm UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/18 "2012-11-05T17:06:01Z")
Have you been to a gastroenterologist or just your primary car physician? I have been on a medication for my IBS that my doctor didn’t know was even useful for IBS that the gastro found. Completely changed my life! ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [November 6, 2012, 3:28pm UTC](https://boards.straightdope.com/t/potential-problems-from-chronic-use-of-extremely-high-dosage-of-loperamide-hcl-imodium/639724/19 "2012-11-06T15:28:40Z")
> [@Bumbazine](#): > > I took Prilosec for a while and it gave me horrible diarrhea, it may be exacerbating your problem. I’m taking something called Ranitidine HCL now, IIRC, which doesn’t bother my gut and has the added benefit of being quite a bit cheaper as well. That’s pretty much what I was thinking - alternatives to Prilosec. [Ranitidine](http://en.wikipedia.org/wiki/Ranitidine) (generic Zantac) works via a different mechanism to Prilosec, Nexium and the other proton pump inhibitors. Whether that’ll be of any benefit or not, of course it doesn’t address your original question (though if such a switch reduced the trots, you might be able to reduce the Imodium).