Long-term Buprenorphine Treatment for Loperamide Use Disorder: A Case Series

Brar, Jessica K; Broyan, Viktoriya R; Allgaier, Jeffrey T; Nye, Larry; Saxon, Andrew J.

doi:10.1097/adm.0000000000000687

Cited by 3 publications

(1 citation statement)

References 19 publications

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“…Limited data is available on treatment options for loperamide use disorder. Methadone and buprenorphine tapering are described in case reports (11)(12)(13) and two case series described long-term buprenorphine treatment (14,15), but the utility of long-term maintenance treatment remains unknown. For Mrs. A., SROM treatment was chosen to avoid CYP metabolism and to reduce adverse events associated with loperamide, such as QTc interval prolongation.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Opioid Use Disorder Associated With Low/Moderate Dose of Loperamide in an Intellectual Disability Patient With CYP3A and P-Glycoprotein Reduced Activity

et al. 2022

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Loperamide is an over-the-counter antidiarrheal for which increasing cases of abuse or misuse are described. We report the onset of opioid use disorder associated with low to moderate doses of loperamide in an intellectual disability patient without previous history of substance use disorder (SUD). Our patient presented strongly reduced activities of CYP3A and P-glycoprotein, which are mainly involved in loperamide metabolism and transport. We suggest that this led to an increase in bioavailability, systemic exposure, and brain penetration thus allowing loperamide to act on the central nervous system and contributing to the development of SUD. Slow release oral morphine (SROM) was chosen as opioid agonist treatment, which successfully contained loperamide use and globally improved her clinical condition. This situation highlights the need for caution and awareness when prescribing loperamide, particularly in vulnerable patients with few cognitive resources to understand the risks of self-medication and little insight into its effects.

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Section: Discussionmentioning

confidence: 99%

Case Report: Opioid Use Disorder Associated With Low/Moderate Dose of Loperamide in an Intellectual Disability Patient With CYP3A and P-Glycoprotein Reduced Activity

et al. 2022

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Buprenorphine/naloxone/loperamide

2020

Reactions Weekly

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Management of loperamide‐related opioid use disorder with buprenorphine within an Australian context: A case report

Dunn,

Wu,

Cordaro

2024

Drug and Alcohol Review

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Loperamide is an over‐the‐counter peripheral mu‐opioid agonist commonly used to manage diarrhoea. When taken in an excessive dose, loperamide's penetration of the central nervous system increases, leading to euphoria, respiratory depression and other opioid effects. A health warning was released in the United States in 2016 with increased reports of excessive loperamide use leading to cardiac conduction abnormalities such as ventricular tachycardia, prolonged QTc and Torsades des Pointes. The growing number of cases is likely due to the increased restrictions on other opioids. Loperamide use disorder has been managed effectively in the United States and the United Kingdom using buprenorphine. In Australia, there have been recent opioid restrictions limiting easy access to opioids. We describe the case of a 28‐year‐old male who was admitted to hospital on multiple occasions with symptoms relating to loperamide use disorder. Buprenorphine was used to manage withdrawal symptoms in the hospital and maintain abstinence from loperamide in the community through an opioid agonist treatment program. To our knowledge, this is the first case study to describe the successful management of loperamide use disorder with buprenorphine within Australia. Our findings suggest that buprenorphine can be used to manage patients with loperamide associated withdrawal and help them remain abstinent upon discharge. Extramedical use of over‐the‐counter opioid medication may be becoming an emerging trend in Australia, and increased monitoring is warranted to prevent detrimental health outcomes.

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Long-term Buprenorphine Treatment for Loperamide Use Disorder: A Case Series

Cited by 3 publications

References 19 publications

Case Report: Opioid Use Disorder Associated With Low/Moderate Dose of Loperamide in an Intellectual Disability Patient With CYP3A and P-Glycoprotein Reduced Activity

Case Report: Opioid Use Disorder Associated With Low/Moderate Dose of Loperamide in an Intellectual Disability Patient With CYP3A and P-Glycoprotein Reduced Activity

Buprenorphine/naloxone/loperamide

Management of loperamide‐related opioid use disorder with buprenorphine within an Australian context: A case report

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