Note: This article is for healthcare providers and may not be helpful for the general public. If you are not a healthcare provider and want more information about loperamide, please visit www.loperamidesafety.org/consumers.
I have no business being alive.
Ask anyone who saved my life — I shouldn’t be here.
When I first got sick, I thought I had a stomach virus. It was the middle of winter and it seemed like all my co-workers were out sick. Unlike them, though, I had been secretly taking high doses of loperamide to relieve the symptoms of opiate withdrawal for several months. I was too busy and didn’t want to go through withdrawal, but the consequences of that decision were about to catch up to me.
Prior to using loperamide, I was taking prescription hydrocodone (Vicodin) for a shoulder and elbow injury. After taking Vicodin for almost a year, I received a shot of cortisone that resolved my shoulder pain — and also cut me off from my supply of hydrocodone. I knew I had become addicted and had a problem, but I didn’t seek treatment because I didn’t want my family or friends to know. Withdrawal started within hours of my last dose. The anxiety, the rapid heartbeat, the sweating, the sneezing, the bone pain, the shooting electric sensations in my extremities — it was torture.
A quick search on the internet led me to some online support groups for addicts. Someone suggested using loperamide, a mu opioid agonist, to ease the agonizing symptoms of opiate withdrawal. I was desperate enough to try it, and it helped. The withdrawal symptoms were gone!
And I got to keep my secret.
No one had to know. I was able to function. I could work. I could hang out with my friends. It seemed like a miracle — until it wasn’t. Eventually, I was taking an incredible 144 tablets a day, which is 36 times the directed daily dose.
Loperamide Cardiotoxicity
My heart stopped Tuesday, February 21, 2012. I’d been feeling nauseous and had been vomiting for a few days. I did my best to keep my pills down, but I wasn’t thinking straight. If I had been, I would have noticed that I became sicker after taking the medication. I started fainting at home, waking up drenched in sweat and having urinated in the bed. I gasped for air, unable to understand what was happening. If this was a stomach virus, it wasn’t like any I had ever experienced before.
I called an ambulance and was rushed to the hospital, where I repeatedly went into cardiac arrest. I was in V-Tach storm degenerating into torsades de pointes — a deadly arrhythmia. In short, I was dying, and fast. I was cardioverted 28 times, wide awake and lucid for the experience.
No one in the ER had ever heard of anyone taking high doses of loperamide before. My toxicology screen came back clean, which didn’t make any sense to the doctors. They kept asking me what I was taking; they didn’t believe that I wasn’t on something that might more obviously cause the arrhythmia. I had brought the bottle of loperamide to show the doctors exactly what I’d been taking. They didn’t believe me and threw the bottle away.
The hospital’s toxicology department conducted research and planned a course of action to save my life. I was intubated and sedated for three days with overdrive pacing of my cardiac rhythm. This got me through the worst of the loperamide toxicity, allowing the drug to process its way out of my system while keeping me hemodynamically stable. But the truth was, no one expected me to live.
Somehow, I survived against the odds. I am here today because of the doctors’ quick action. Because they cared. Because they paid attention and learned from me.
Others have not survived as I did.
Advocating for Patients
Since this happened to me, much has changed. I started a website to tell my story and compiled all the relevant medical articles that came out in the years subsequent to my overdose. I aim to inform and educate people with an opioid addiction as well as medical personnel.
In testament to those who saved my life, I am not only clean and sober but training to be a nurse. I want to contribute and save lives like the healthcare professionals who saved mine. We, as medical personnel, can do better for our patients.
Based upon my own experience, I would ask healthcare professionals to consider the following:
Believe your patient. Your patient is the number one source of information about their condition. If they are courageous enough to come to you for help because they are taking too much of something, whether an antidiarrheal drug or something else, believe them. Maybe it’s weird, but that doesn’t mean they don’t deserve compassionate treatment.
Ask the right questions. If you are working with someone you know is in a treatment program for opioid abuse, consider asking them about other things they are taking, such as loperamide. Be cautious in your approach to avoid unintentionally triggering them to seek it out for abuse. If they admit to using loperamide, ask them exactly how much. Warn them that taking very high doses can lead to serious cardiac effects and even death — even if they feel fine now.
Take it seriously. People will experience opioid withdrawal symptoms from loperamide if they have been taking it at supratherapeutic levels. Consider any opioid replacement therapy very carefully and prescribe medications such as clonidine and hydroxyzine as you would for any other opiate addiction.
Please take these patients seriously. Early intervention is the best method to prevent abuse.