In addition to being interesting articles on their face, they are also the first ones in the literature that discuss withdrawal symptoms with regard to loperamide. Up until now, it’s only been “anecdotal” (though we ALL know the withdrawal is excruciating) — the conventional medical belief is that loperamide cessation causes mild to no withdrawal symptoms.
The second article in particular discusses the use of buprenorphine (Suboxone/Subutex) in the ED setting for opiate withdrawal symptoms resultant from loperamide abuse — to startlingly bad results due to a particularly vicious precipitated withdrawal. This is important, serving as a warning to others who might consider using Suboxone to get off loperamide!
(Same goes for Narcan [naloxone], by the way. Cardiac arrhythmias are made worse due to precipitated withdrawal.)
Both articles encourage further research.
Abstracts from the 2015 Annual Meeting of the North American Congress of Clinical Toxicology (NACCT)
Clinical Toxicology (2015), 53, 639–777
Copyright © 2015 Informa Healthcare USA, Inc.
ISSN: 1556-3650 print / 1556-9519 online
“Cessation of loperamide abuse can lead to withdrawal symptoms similar to those seen with other centrally acting opiates.
“Conclusion: While usually considered safe, clinicians should be aware of the abuse-potential of loperamide when used in conjunction with CYP3A4 and p-glycoprotein modulators like grapefruit juice and cimetidine.”
50. Buprenorphine induced acute precipitated withdrawal in the setting of loperamide abuse
William Eggleston2, Nicholas Nacca1, Jeanna M Marraffa1
1SUNY Upstate Medical University, Department of Emergency
Medicine, Syracuse NY USA, 2SUNY Upstate Medical University,
Upstate New York Poison Center, Syracuse NY USA
“Conclusion: Loperamide abuse may be associated with a withdrawal syndrome in the setting of drug discontinuation. Use of buprenorphine in patients actively intoxicated with loperamide may cause rapid reversal of mu-receptor agonism and induce acute precipitated withdrawal.”