Emerging Imodium Litigation Over Heart Damage


Imodium, though not an opioid, may increase the effect of opioids when consumed at the same time. Imodium, along with its generic forms, are intended to act on the digestive system and are the #1 best-selling drug to treat diarrhea. However, taking too much can cause serious cardiac problems, and the effects are worsened with the interaction of other common drugs like Zantac.

Heroin-like High

Opioid addicts and many young people are turning to Imodium A-D and similar over-the-counter medications to get a heroin-like high.

Imodium was approved by the FDA in 1976 has been available over-the-counter in the US since 1988. The FDA started getting reports of serious adverse events in 2010. The active ingredient — Loperamide Hydrochloride — has euphoric effects and information on how to facilitate such effects is easily available.

“Loperamide’s accessibility, low cost, over-the-counter legal status, and lack of social stigma all contribute to its potential for abuse,” said lead study author William Eggleston, PharmD, of the Upstate New York Poison Center at Upstate Medical University.

“The majority of reported serious heart problems occurred in individuals who were intentionally misusing and abusing high doses of loperamide in attempts to self-treat opioid withdrawal symptoms or to achieve a feeling of euphoria,” the agency said.

People abusing the drug took 50 to 300 milligrams to induce a high. Litigation is gradually building against the manufacturer. All products sold under the Imodium brand name are manufactured by Janssen Pharmaceuticals Inc. and Johnson and Johnson Consumer Inc.

About 2.1 million people addicted to opioid painkillers, and there is widespread fear the seemingly harmless medication could contribute to the epidemic. One in five Americans has a family member addicted to painkillers, according to a Kaiser Family Foundation survey.

“Abuse of loperamide continues in the United States, and taking higher than recommended doses can cause serious heart problems that can lead to death,” said Acting FDA Commissioner Ned Sharpless, M.D.

FDA Action

In 2016, the FDA issued a safety announcement that it had received numerous reports of serious heart issues and medication reactions in patients taking prescription loperamide and over-the-counter Imodium products. The FDA also warned that taking higher than recommended doses of medicine Imodium, including through abuse or misuse of the product, can cause serious heart problems that can lead to death.

A Heart Alert warning was added to loperamide Drug Facts labels in the spring of 2017 to warn consumers that taking more than directed can cause deadly heart problems.

Even so, Amazon sells a 192-pack of generic Loperamide for $13.48 or 7 cents per tablet. Tablets contain 2 mg of Loperamide, and the maximum approved daily dose for adults is 8 mg per day for OTC use and 16 mg per day for prescription use.

Like Morphine

Imodium is a synthetic anti-diarrheal indicated for the control of the symptoms of diarrhea, including Travelers’ Diarrhea (consumption of contaminated foods or beverages). The medication is designed to manage periodic episodes of diarrhea, not chronic diarrhea, which can be an indication of a more complicated and serious medical condition.

Like morphine, Imodium works by binding to opioid receptors in the digestive tract, which has the effect of slowing digestion. When food moves slowly through the intestines and colon, patients’ stools will be more solid, which is one of the reasons many patients experience constipation when taking prescription opioids.

Imodium, therefore, mimics the effects of opioids on the digestive system in addition to increasing tone of the anal sphincter. Patients usually find relief from their diarrhea symptoms within a short amount of time.

It is sold under these brand names:

  • Imodium
  • Imodium A-D
  • Imodium A-D EZ Chews
  • Imodium Multi-Symptom Relief

When taken in high doses, Imodium can cause the following cardiac issues:

  • Arrhythmias (irregular beating of the heart)
  • QT Interval Prolongation (rapid or chaotic heartbeats)
  • Torsades de Pointes (ventricular tachycardia or rapid beating of the lower heart chambers)
  • Syncope (temporary loss of consciousness or fainting spell)
  • Cardiac Arrest

“These are serious heart complications that can lead to patient death. Cardiac arrest is a particularly frightening potential side effect for these drugs, which can often lead to death in patients,” according to the Parker Waichman law firm.

Drug Interactions

Cardiac complications and cardiac arrest can be amplified when patients take loperamide or Imodium in combination with certain other medications:

• Tagamet HB (cimetidine)
• Zantac (ranitidine)
• Prevpac (lansoprazole)
• Biaxin (clarithromycin)
• Lopid (gemfibrozil)
• Omnel/Sporanox (itraconazole)
• Ketoconazole
• Nuedextra (quinidine)
• Qualaquin (quinine)
• Kaletra/Norvir/Technivie (ritonavir)

Loperamide and Imodium can also cause severe allergic, which will often occur shortly after taking a dose of the medications. Some patients can experience anaphylaxis and anaphylactic shock, as well as other hypersensitivity reactions.

“The propensity for these drugs to cause dependence and cardiac events is exceptionally alarming,” says the Parker Waichman law firm.

Dan Gale, an ER doctor in Wisconsin, said “The biggest safety issue is what happens to the heart. It disrupts our electrical pathways in our heart. When it happens, it’s like flipping a switch. It’s not like you feel a little bit worse and a little bit worse and then you die. You just collapse.”

People overdosing on loperamide may suffer sudden, repeated losses of consciousness caused by a fall in blood pressure.


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