Understanding Loperamide (Imodium)

Loperamide is the generic-name for Imodium, an antidiarrheal agent that is available both over-the-counter and by prescription. Loperamide is used for the control and symptomatic relief of acute nonspecific diarrhea and of chronic diarrhea that is associated with inflammatory bowel disease (IBD). The drug is also indicated for reducing the volume of discharge from ileostomies – surgery to create an opening for waste to leave the body through the abdomen. Loperamide works by slowing down the flow of fluids and electrolytes into the bowel, effectively decreasing both the movement of the bowel and the frequency of bowel movements. The medication comes as either a tablet, capsule, or liquid solution that is to be taken by mouth.

Loperamide Effects and Abuse

Taking loperamide can help regulate bowel movements and reduce dehydration in consumers that are experiencing severe, chronic, or acute diarrhea. In addition to these benefits, the medication can produce a variety of negative and potentially harmful effects as well. These side effects can range from mild to severe and include any of the following:

  • Dry mouth
  • Abdominal cramping
  • Dizziness
  • Drowsiness
  • Colic
  • Vomiting
  • Headache
  • Nausea
  • Constipation
  • Problems urinating

The risk that adverse effects will occur is amplified when the drug is abused, particularly when large amounts of loperamide are taken. Abuse of the medication has greatly risen within the past 10 years, and many health officials are attributing this to be a direct result of the opioid epidemic. People have discovered that when taken at very high doses, loperamide can produce similar effects to those of opioids. The drug is an opioid agonist, and therefore has the capacity to induce a high by activating opioid receptors in the brain. Due to the drug’s chemical makeup, the medication can’t cross the blood-brain barrier in low doses and won’t produce a high unless taken in excessive amounts or in combination with other drugs.

The drug is inexpensive, and compared to the price of both illicit and prescription opioids, extremely affordable – the cost of 200 capsules of generic loperamide can be as low as $10. Individuals abusing the drug will then buy and take anywhere from 50 to 400 pills in a single day in order to achieve a sense of euphoria similar to that of oxycodone and heroin.

Loperamide’s accessibility, low cost, over-the-counter legal status and lack of social stigma all contribute to its high potential for abuse.

- William Eggleston, PharmD, Upstate New York Poison Center Syracuse

Additionally, many people are using loperamide to self-medicate withdrawal symptoms associated with opioid use disorders. Rather than using loperamide to simulate the euphoric high of opioid drugs, people are now taking the drug as a way to treat physical dependence to opioids. Loperamide abuse for this reason has become so pervasive and problematic it has been dubbed the “poor man’s methadone.” Unfortunately, using loperamide as a replacement for opioids also requires very high doses of the medication, which can lead to overdose. Ingesting large and frequent amounts of loperamide carries a high risk of experiencing cardiac arrhythmias and respiratory depression, which can lead to death.

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Signs of Loperamide Addiction

There is a common misconception that because loperamide is available over-the-counter, it’s safe. However, that’s simply not true. High doses of any drug can lead to the development of a physical dependence if chronically abused, including loperamide. Even a person that was simply taking higher doses of loperamide due to gastrointestinal or diarrheal pain can become accustomed to the presence of the drug in the system and effectively develop an addiction. After a physical dependence has developed, users will experience withdrawal symptoms when attempting to stop taking the drug. These symptoms are similar to those experienced with opioid withdrawal and include nausea, vomiting, anxiety, irritability, depression, cramps, diarrhea, excessive sweating, and muscle aches and pains.

Signs that indicate someone may have a loperamide addiction include:

  • Taking loperamide after it’s no longer needed or longer then prescribed
  • Needing more and more of the drug to elicit the same effects
  • Spending the majority of the day thinking about loperamide: how to get more, the effects it produces, and when to use it
  • Constantly using the medication and being unable to stop
  • Faking symptoms to get loperamide prescriptions
  • Substituting the drug for opioids to achieve a sense of euphoria or a high
  • Sudden changes in physical appearance, hygiene, and behavior

Another telling sign of loperamide addiction is abusing the medication in combination with another substance to produce a greater euphoric high. Alcohol is commonly abused alongside loperamide because it heightens the side effects of both, causing the individual to experience a more intense intoxication. Engaging in polydrug use such as this significantly raises the chance of deadly overdose due to cardiotoxic effects.

Loperamide Abuse Statistics


More Potent

When compared to morphine, loperamide has been shown to be 40-50 times more potent in producing antidiarrheal and central nervous system (CNS) depressive effects.



Researchers also found a 71% rise in calls related to loperamide misuse to poison control centers across the United States between 2011 and 2014.



According to the American College of Emergency Physicians, between 2010 and 2011 web-forum postings about oral loperamide abuse increased by 10 times.

Get Help for Loperamide Addiction

All drugs, including those sold over-the-counter without a prescription, can be dangerous when not used as directed. Using loperamide to get high or even to relieve opioid withdrawal symptoms is a form of drug abuse. If you think that you may be addicted to loperamide or are using the drug to treat opioid dependence, contact a treatment provider today. There are multiple treatment options available for loperamide addiction.