I am here to tell you, I took my last dose of loperamide about 48 hours ago. I had a really tough time with the last and final measly doses after tapering down over a couple of weeks. Seems stupid, but I came to believe it was just a psychological hold, those last few milligrams, so I finally just jumped and stopped taking them altogether. The withdrawals suck, but in truth, are mild compared to what it would have been like if; A: I was on something stronger like Vicodin, etc.; or B: If I’d not tapered off slowly. Right now, I don’t want to redose despite feeling like I’m going to crawl out of my skin, mainly because I don’t want to have to keep going through it over and over. At some point, I just need to say “enough is enough,” right? So I’m done and waiting for the day when my brain begins the process of healing my body. Tick tock. Tick tock.
So as I said, withdrawal sucks, but isn’t as bad as it could be. Of course, ask me again at 1am when I’m wide awake (AGAIN) and the sensation of crawling ants under my skin won’t let me sleep. But with the medications I’m on, I’m surviving.
I have changed over to the AA meetings as the NP had suggested and am (as of right now) doing okay with them. Life is still a daily struggle, but it helps knowing I have people on my side. Yes, I’m still seeing the square-jawed NP for my medication management. I tried looking into therapy, but this stupid ‘burg is about as dry as a bone when it comes to such things (for those of us under the glorious Medicare plan, that is). Until I get a car, I think talk therapy is gonna have to be put on the back burner. I accept that and look forward to the day when I have wheels again — which may be soon, I hope. Fingers crossed and a small prayer.
Now, because it’s bothering me that I haven’t done this yet, I present: A brief public service announcement on the hazards of loperamide misuse:
For anyone wanting to know about using loperamide for opioid withdrawal. Loperamide (brand name: Imodium) is NOT a viable replacement for any opioid/opiate drug — whether Vicodin, Heroin, Oxycontin, or whatever you prefer. If you require a replacement drug, you will need buprenorphine (brand name: Subutex or Suboxone) or methadone. Those drugs are safe and FDA approved for opioid withdrawal when prescribed by a licensed physician.
Loperamide is an atypically-acting opioid of the piperidine class, binding mostly to the mu opioid receptors in the gut and appears to act peripherally as well. It crosses the blood brain barrier in small amounts, immediately mediated out by a chemical called P-glycoprotein which your brain produces to protect you from the effects of the drug (even in high doses). It is true you won’t get high on it, but you may get a slight, warm fuzzy feeling in extremely high doses. So for those thinking there are no Central Nervous System (CNS) effects, I assure you, there are (pinned pupils being just one obvious sign). Loperamide, when taken in the recommended doses (2-4mg at the start of diarrhea symptoms, maximum 16mg per day), is considered safe and approved by the FDA; odds are are you won’t experience any problems if you are taking it as directed.
BUT…. for loperamide in higher “mega” doses, there is little-to-no actual scientific data available. Since prescription drug and opioid abuse has skyrocketed in the last few years, anecdotal evidence has become available due to the popularity of information sharing via internet boards, social media sites, personal websites, and YouTube videos — many of which promote the use of loperamide as a replacement or withdrawal drug for opioids.
Scientific data is scant at best. Recently, a white paper has been written about my experience (presented at a 2013 Toxicology conference) describing SEVERE cardiac effects from high doses of loperamide. Right now, the exact reason why it causes heart rhythm disturbances in such misuse/abuse situations is poorly understood because, as I mentioned, there’s very little scientific data available on the drug in high doses. (Personally, I think Loperamide may or may not have some kind of dose-dependent cumulative effect, perhaps within the cardiac muscle itself, but that’s just my opinion which, since I don’t actually have a PhD in biochemistry, doesn’t matter much anyway.)
All things considered, it has been suggested based on three known incidents in this one hospital, that those who abuse loperamide can develop deadly cardiac arrhythmias (in these specific cases, typically patient presents with syncope [fainting] and cardiac arrest due to ventricular tachycardia degenerating into polymorphic ventricular tachycardia, aka, Torsade de Pointes).
Getting shocked back to life with defibrillators dozens of times while wide awake and lucid for the experience is FAR worse than going through withdrawal, I assure you.
Like others, I’ve read the websites, online boards, and seen the Youtube videos where it is has become a popular recommendation — not only suggested but presented as fact that addicts could simply consume anywhere from a few dozen or a couple hundred loperamide tablets to help them through withdrawals. THIS IS A LIE. Well, sort of. It does work from the perspective that high dose loperamide does alleviate the physical symptoms of withdrawal. But at what price? Back when all this started, I did a lot of research before I started using the loperamide. I read bulletin boards, collected anectotal evidence, read PDRs, and researched a handful of white papers (what little I could find) and came to the conclusion that loperamide seemed like a fairly innocuous drug that could help prevent or at least alleviate my withdrawal symptoms as people were suggesting it. The way I saw it, since others had successfully used it in high doses, and nobody reported them dead, it seemed safe to “repurpose” the drug in that way. That’s how it all began.
Then I discovered the ugly truth: that loperamide, like any opioid, has a tolerance. Take it for a while, then the withdrawal symptoms start rearing their ugly heads. It became a “new” addiction (and one that didn’t get me high, either). I never took the time to withdraw from the loperamide — there was never time. It was never convenient. I always had some excuse. Then the dosage escalated up and up. Eventually, I got sick in a way that nobody would have expected. Not toxic megacolon. Not liver damage. Not even kidney damage. It was my heart — I was near death, eventually on life support, and doctors were baffled. Then I survived, and there were more cases. I was the proverbial canary in the coal mine.
I survived in no small part due to the fact that I was the only one brave enough to fess up that I was addicted to what most people think of as a diarrhea drug. I went to the ER and confessed what I was doing and exactly how much I was taking. I talked the doctors through it — what the drug was, how I knew what it did, why I was taking it. I was VERY lucky to be conscious for any of this. In one white paper I read recently, the patient was dead long before anyone could figure out what happened. My doctors learned because of me. How many others who came before me died because they showed up at the ER coming in and out of consciousness from a deadly arrhythmia and weren’t so forthcoming about their usage? Loperamide doesn’t show up on a normal tox. screen the way that, say, Vicodin would — so if the patient isn’t willing to admit to it, that patient could die. My doctors are now getting the word out to poison control centers around the country how to save people from loperamide overdose. Hopefully, we will save a few lives.
So — bottom line time. If you’re reading this because you’re thinking of taking high-dose loperamide, then seriously, don’t do it. Don’t go down the loperamide path like I did. It’s false hope. Ask for help. Go to your doctor and beg for help — it’s out there if you seek it. It’s not a perfect system, and withdrawing sucks no matter how you look at it, but if you can trust me for five seconds, believe me when I say using loperamide in high doses is not worth it. Opioid withdrawal won’t kill you, but that high-dose loperamide will.
And if, perchance, you are reading this because you are already addicted to loperamide, welcome to my world. There is help for you.
First of all, if you ever discover yourself getting dizzy, eyes unable to focus, or nauseous or vomiting an hour or couple hours after dosing (it feels a bit like the stomach flu) or worse, waking up gasping for air or passing out or fainting, call 911 and for God’s sake, confess! Tell them exactly what you’re taking. Take the bottle with you if you can. And tell them if you’re taking anything else or anything to potentate it (like quinine, grapefruit juice, or omeprazole — yes, you!) and tell them EXACTLY how much you took — don’t be shy. I was on 144 loperamide tablets a day when it happened to me. Another guy was over 300 at a time. Just be honest; your life literally depends on it.
Secondly, if you’re not in crisis, talk to your doctor about getting off the loperamide. He/she might initially look at you like your nuts or tell you you’re exaggerating, but insist that they look it up and/or call the poison control center. At the risk of outing myself, I’m including the poison control center’s logo herein for informational and educational purposes only (my blog is absolutely NOT endorsed by them). Give that number to your doctor.
What to expect afterward? Withdrawal treatment from loperamide addiction will depend on the symptoms and a plan of action must be developed with your doctor. The number one thing they will likely want to do is get you off the high-dose loperamide immediately. My doctor has been treating my case like ordinary opioid withdrawal, but it hasn’t been easy because (as I mentioned) it isn’t an ordinary opioid. It acts peripherally, so I experience a lot of physical issues such as restless legs syndrome, and a surprising number of central nervous system-based symptoms such as depression, and severe insomnia and agitation. Yes, even with a slow taper. The medications help but do not eliminate the symptoms.
I should also emphasize that when I went through withdrawal this time, I chose to taper down from the drug against the advice of my doctors. I don’t recommend it. Eventually, I have managed to stop taking it, but not without sacrifice. Make no mistake: as I said, loperamide is similar to other opioids, but its withdrawal symptoms last considerably longer and are very devious and frustrating to deal with even with a slow taper. Individual experience may differ. But the most important thing is work a plan with your physician. This won’t be easy, so you’ll need help. Advocate for your own health!
If you’re insistent on detoxing off the loperamide yourself, expect a rough ride, and I wish you the best of luck. Take vitamins, drink plenty of water, and take lots of hot baths — you probably know the routine. Just leave the lope out of the equation this time.
Finally, if you are a doctor treating a patient who is experiencing v-tach due to loperamide abuse/misuse or who is addicted to loperamide and needs to get into a treatment program, please call the Poison Control number listed in the logo above immediately to discuss the case with the doctors on staff. They know (almost! ha!) as much as I do about it and will be able to guide you through developing an effective treatment plan for your patient.
One last time, with feeling: Yes, opioid withdrawal sucks. There are no two ways about it. But using loperamide is not a way out, it will just making things worse. Opioid withdrawal won’t kill you, but that high-dose loperamide will.
Thank you for listening.
ADDITIONAL LINKS on THIS SITE:
- Mad Margaret’s Loperamide Medical Article Clearinghouse
- More on the Loperamide Thing
- Loperamide No More Part 2
- Going Through Loperamide Withdrawal — Tips on Surviving the Addiction