title: Surveillance of loperamide ingestions: an analysis of 216 poison center reports.
abstract: BACKGROUND
  Loperamide was approved for nonprescription use in 1988. While efficacy is well documented, there are few data on loperamide overdose and management.
  
  
  METHODS
  Eight poison centers participated in a prospective study enrolling 216 patients.
  
  
  RESULTS
  Where the amount ingested was known, it ranged from 0.03 to 0.94 mg/kg. One- to 3-year-olds were involved in 57.9% of ingestions. Ingestion was unintentional in 182 cases (84.3%), including 59 patients with therapeutic errors (27.3% of all cases). Dispensing cup errors were implicated in 23 cases; 15 patients assumed the dispensing cup was the unit of measure. No symptoms developed in 63.0%; 27.8% had related symptoms. No related symptoms were life-threatening, and no fatalities occurred. The most frequent symptoms were drowsiness (15.7%), vomiting (4.2%), and abdominal pain or burning (3.7%). The frequency of related symptoms was compared in patients receiving the most frequently utilized decontamination modalities: ipecac alone, activated charcoal alone, lavage and activated charcoal, and ipecac and activated charcoal. Compared to the 112 patients who received no decontamination, only the ipecac-treated group demonstrated a significant reduction in the frequency of related symptoms; 13.9% of patients given ipecac alone (without other gastric decontamination) had related symptoms compared to 33.0% of patients who received no decontamination. Three patients received naloxone for CNS symptoms related to loperamide; two responded and the response of the third was unknown.
  
  
  CONCLUSIONS
  Within the range of doses implicated in this study (up to 0.94 mg/kg), there were no life threatening clinical effects and no fatalities. Development of a management protocol is complicated by the absence of a predictable clinical response in each dose range. The data suggest that children over six months with single acute ingestions up to 0.4 mg/kg, and possibly higher, can be safely managed at home, without gastric decontamination.
authors.affiliation: National Capital Poison Center, Washington, DC 20016, USA.
authors.forename: T
authors.initials: T
authors.lastname: Litovitz
authors.forename: C
authors.initials: C
authors.lastname: Clancy
authors.forename: B
authors.initials: B
authors.lastname: Korberly
authors.forename: A R
authors.initials: AR
authors.lastname: Temple
authors.forename: K V
authors.initials: KV
authors.lastname: Mann
mesh_terms: D000293:Adolescent; D000328:Adult; D000930:Antidiarrheals / Q000506:poisoning*; D002606:Charcoal / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D062787:Drug Overdose / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007486:Ipecac / Q000627:therapeutic use; D008139:Loperamide / Q000506:poisoning*; D008297:Male; D011039:Poison Control Centers; D011446:Prospective Studies
chemical_list: D000930:Antidiarrheals; D002606:Charcoal; D008139:Loperamide; D007486:Ipecac