SURVEILLANCE OF LOPERAMIDE INGESTIONS - AN ANALYSIS OF 216 POISON CENTER REPORTS

Background: Loperamide was approved for nonprescription use in 1988, W hile efficacy is well documented, there are few data on loperamide ove rdose and management. Methods: Eight poison centers participated in a prospective study enrolling 216 patients. Results: Where the amount in gested was known, it ranged from 0.03 to 0.94 mg/kg. One- to 3-year-ol ds were involved in 57.9% of ingestions. Ingestion was unintentional i n 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 sym ptoms developed in 63.0%; 27.8% had related symptoms. No related sympt oms were life-threatening, and no fatalities occurred. The most freque nt symptoms were drowsiness (15.7%), vomiting (4.2%), and abdominal pa in or burning (3.7%). The frequency of related symptoms was compared i n patients receiving the most frequently utilized decontamination moda lities: ipecac alone, activated charcoal alone, lavage and activated c harcoal, and ipecac and activated charcoal. Compared to the 112 patien ts who received no decontamination, only the ipecac-treated group demo nstrated a significant reduction in the frequency of related symptoms; 13.9% of patients given ipecac alone (without other gastric decontami nation) had related symptoms compared to 33.0% of patients who receive d no decontamination. Three patients received naloxone for CNS symptom s related to loperamide; two responded and the response of the third w as unknown. Conclusion: Within the range of doses implicated in this s tudy (up to 0.94 mg/kg), there were no life threatening clinical effec ts and no fatalities. Development of a management protocol is complica ted by the absence of a predictable clinical response in each dose ran ge. The data suggest that children over six months with single acute i ngestions up to 0.4 mg/kg, and possibly higher, can be safely managed at home, without gastric decontamination.