Use and abuse of loperamide . . . and other storiesBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m346 (Published 06 February 2020) Cite this as: BMJ 2020;368:m346
Loperamide as a drug of abuse
Loperamide is an over-the-counter drug frequently bought to treat travellers’ diarrhoea. At therapeutic doses, it exerts its action peripherally through activation of mu-opioid receptors in intestinal tissue. However, at higher doses it can cross the blood-brain barrier and lead to mood changing effects of the sort seen with other mu-opioid agonists such as morphine. Online surveys from the UK and US suggest that non-medical use of loperamide is widespread both for its euphoric properties and to mitigate the unpleasant effects of withdrawal from other opiates (QJM doi:10.1093/qjmed/hcz215).
The fragility index
The fragility index has …