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The U.S. Food and Drug Administration (FDA) announced a warning about the use, or misuse of Imodium — the common over-the-counter (OTC) diarrhea medicine.  Imodium is the brand name for the prescription medication loperamide.

Loperamide is a commonly used over-the-counter (OTC) and prescription medicine that helps control symptoms of diarrhea.  It’s sold under the OTC brand name Imodium, as store brands, and in generic form.

The FDA warns that taking higher than recommended doses of loperamide, or Imodium — intentionally or unintentionally — can result in serious heart problems, including abnormal heart rhythms.

In addition, misuse or abuse of loperamide, or Imodium can also lead to death.

Imodium Health Risks

Risks of Imodium

The majority of serious heart problems reported occurred in people who intentionally misused or abused the antidiarrheal by taking high doses “in attempts to self-treat opioid withdrawal symptoms or to achieve a feeling of euphoria.”

The risk of these serious heart problems are increased when high doses of loperamide are taken with several kinds of medicines that interact with loperamide.

In a June 7, FDA safety announcement, the agency provides a partial list of drugs that may cause adverse effects for people when mixed with Imodium or loperamide. The extent of the effects of each drug is unknown.

Examples of drugs that can potentially interact with Imodium or Loperamide

Generic Name                              Examples of Brand Name(s)

  • cimetidine                               Tagamet HB
  • clarithromycin                         Biaxin, Prevpac
  • erythromycin                           E.E.S., Ery-Tab, Eryc, Eryped, PCE
  • gemfibrozil                              Lopid
  • itraconazole                            Onmel,Sporanox
  • ketoconazole                          Available by generic only
  • quinidine                                 Nuedexta
  • quinine                                    Qualaquin
  • ranitidine                                 Zantac
  • ritonavir                                   Kaletra, Norvir, Technivie, Viekira Pak

(Quinine and its isomer quinidine are also present in Tonic Water.)

From 1976 through 2015, the FDA received 48 case reports of serious heart problems associated with use of the loperamide, or Imodium. This reported number only includes cases that were submitted to the FDA.  There are likely additional cases that were not reported.

Thirty-one of the cases resulted in hospitalizations.  Most unfortunately, 10 patients died. The serious heart problems occurred mostly in patients who were taking doses that were much higher than recommended.

However, in other cases, patients were taking the recommended dose of loperamide, but they were also taking interacting medicines, causing an increase in loperamide levels.

Recommendations

When taking loperamide or Imodium, people are advised to follow the dosing recommendations on the label.  Taking higher than recommended doses, either intentionally or unintentionally, may lead to abnormal heart rhythms and serious cardiac events — leading to death.

Additionally, drug interactions with commonly used medicines also increase the risk of serious cardiac adverse events.

Stop taking loperamide and contact your health care professional if your diarrhea lasts more than two days. Seek medical attention immediately by calling 911 if you or someone taking loperamide experiences any of the following:

  • Fainting
  • Rapid heartbeat or irregular heart rhythm
  • Unresponsiveness, meaning that you can’t wake the person up or the person doesn’t answer or react normally

Ask a pharmacist or your health care professional if you are not sure how much loperamide to take, how often to take it, or whether a medicine you are taking may interact with loperamide.

Patients, consumers, and health care professionals are urged to report side effects involving loperamide or other medicines to the FDA MedWatch program.

The FDA plans to continue evaluating this safety issue and determine if additional FDA actions are needed.

If you are not sure if a medicine you are taking interacts with loperamide, or Imodium, ask a pharmacist or your health care professional.


Featured image courtesy of Kristoferb via Wikimedia Commons | Cropped and Resized | CC-BY-SA-3.0.

Wire-bristle brushes have the potential of causing serious harm.  The wire bristles from the brush can fall off and find ways into a person’s food.

Though wire-bristle brushes do a great job in cleaning grills, they are “a potential consumer safety issue,” according to a team of researchers.Dangers of Wire-Bristle Brushes

Danger of Wire-Bristle Brushes

Wire-bristle brushes are great tools for cleaning a grill before and after barbecuing.  However, loose bristles have the potential to fall off the brush during cleaning.  The wire bristles may end up in the grilled food.  If the food and wire bristles are consumed, this can lead to injuries in the tonsils, throat, and mouth.

A new study conducted at the University of Missouri School of Medicine identified more than 1,600 emergency department visits that occurred as a result of injuries caused by wire-bristle brushes between 2002 and 2014.

Based on their findings, the researchers advise people to inspect their food very carefully after grilling or take into consideration alternative methods for cleaning a grill.

In a recent news release, co-author of this new study, David Chang, M.D., and associate professor of otolaryngology at the MU School of Medicine, offered the following caution:

“One little bristle unrecognized could get lodged in various areas of the body, whether in the throat, tonsil or neck region.  If the bristle passes through those regions without lodging itself, it could get stuck further downstream in places like the esophagus, stomach or the intestine. The biggest worry is that it will lodge into those areas and get stuck in the wall of the intestine. The bristles could migrate out of the intestine and cause further internal damage.”

Dr. Chang and his team of researchers reviewed consumer injuries listed in the United States National Electronic Injury Surveillance System (NEISS) database.  The researchers were able to review records of how many emergency department visits were caused by wire-bristle injuries between 2002 and 2014.

An estimated 1,698 injuries were reported by emergency departments during the twelve years researched. The most prevalent injuries reported were in a patient’s tonsils, throats, and oral cavities.  Some injuries required surgery.

Dr. Chang said that the number of injuries found from wire-bristle brushes could be even larger than the estimated 1,698.  The study did not include injuries that were treated at urgent care facilities or other outpatient settings.

Dr. Chang warned that wire-bristle brushes used in grilling is “a potential consumer safety issue.”

“Wire-bristle brush injuries are a potential consumer safety issue, so it is important that people, manufacturers and health providers be aware of the problem.  If doctors are unaware that this problem exists, they may not order the appropriate tests or capture the correct patient history to reach the right diagnosis.”

Safety Tips for Grilling

Here are a few safety tips people should use when grilling.

  • Use caution when cleaning grills with wire-bristle brushes — examining brushes before each use and discarding if bristles are loose.
  • Inspect your grill’s cooking grates before cooking, or use alternative cleaning methods such as nylon-bristle brushes, or balls of tin foil.
  • Inspect grilled food carefully after cooking to make sure bristles are not stuck to the food.

Dr. Chang adds the following information on what to do in case of injury.

“If cautionary measures fail and individuals do experience problems with swallowing or pain after eating something that has been barbecued or grilled, they should seek advice from a physician or an emergency department and let the physician know that they were just at a barbecue event or they just grilled food.”

The new study, “Epidemiology of Wire-Bristle Grill Brush Injury in the United States, 2002-2014,” was published in Otolaryngology-Head and Neck Surgery.


Featured image courtesy of Manuel QC via Wikimedia Commons | Cropped and Resized | CC-BY-SA-2.0