Recently (on 07 June 2016), the FDA published a warning associating serious cardiac

events with large amount of loperamide use (abuse). Loperamide is a generic for
brand medication Imodium used for managing diarrhea. This warning might have
received impetus from recent studies [3-5] published by toxicologists and emergency
room physicians, each involving one to five patients who consumed large amounts of
loperamide, and a parallel report from the The National Drug Early Warning System
(NDEWS) published on 13 May 2016 that collected information on use of loperamide to
get high or alleviate opioid withdrawal symptoms.

Significantly, the first (oldest) scientific paper [2] cited in the NDEWS report
and the one that identified/reported this problem was way back in 2013. It was an
unexpected outcome from PREDOSE, a Kno.e.sis/CITAR collaborative project at Wright
State University that was funded by NIH/NIDA. Preliminary results were published
in 2012 [1]. In this work, our team analyzed social media, specifically Web forums
dedicated to prescription drug use/abuse, and came up with insights derived from
users/abusers own online posts, substantiating sporadic earlier reports with
limited details from poison control centers (see the NDEWS report). Compared to a
few (low 10s) cases reported by poison control centers, our study had identified
1290 cases. The recent small scale studies involving one to five cases in [3-5] can
of course provide medical details that social media based studies cannot, and hence
these should be seen as a good complement to what we originally observed. In
particular [4] reconfirms the use of online information for self treatment and
abuse.

Please feel free to contact Ramina or me at amit@knoesis.org (PIs of the PREDOSE

project) for further details, or discuss our subsequent work in eDrugTrends project
that studies social media conversation to understand impact for marijuana
legalization choices [6].

[1] Raminta Daniulaityte, Robert Carlson, Russel Falck, Delroy Cameron, Sujan
Udayanga, Lu Chen, Amit Sheth. A Web-Based Study of Self-Treatment of Opioid
Withdrawal Symptoms with Loperamide. The College on Problems of Drug Dependence
(CPDD), Palm Springs, CA USA, June 9-14, 2012:

[2] Raminta Daniulaityte, Robert Carlson, Rusell Falck, Delroy Cameron, Sujan
Parera, Lu Chen, and Amit Sheth. I just wanted to tell you that loperamide will
work: A web based study of extra-medical use of loperamide. Drug and Alcohol
Dependence, 2013, 130:241244.

[3] JM Marraffa, MG Holland, RW Sullivan, BW Morgan, JA Oakes, TJ Wiegand, MJ

Hodgman. Cardiac conduction disturbance after loperamide abuse. Clin Toxicol
(Phila) 2014; 52:952957. DOI: 10.3109/15563650.2014.969371

[4] Lucas Marzec, David Katz, Pamela Peterson, Lauren Thompson, Mark Haigney, and
Mori Krantz. Torsade de Pointes Associated with High-dose Loperamide Ingestion, The
Journal of Innovations in Cardiac Rhythm Management, 6 (2015), 18971899.

[5] William Eggleston, Kenneth H. Clark, Jeanna M. Marraffa. "Loperamide Abuse

Associated With Cardiac Dysrhythmia and Death. Annals of Emergency Medicine,
Published online on 29 April 2016. DOI:
http://dx.doi.org/10.1016/j.annemergmed.2016.03.047
[6] Francois Lamy, Raminta Daniulaityte, Ramzi Nahhas, Silvia Martins, Edward
Boyer, Robert Carlson. "Those edibles hit hard": Exploration of Twitter data on
cannabis edibles in the U.S. Drug and Alcohol Dependence. 2016 :64-70. Related
WSU News article: Boonshoft School of Medicine researchers studied tweets to learn
more about use of marijuana edibles.