An Unusual Case of Loperamide Toxicity in a Neonate – A Case Report

Abstract

Introduction: Loperamide is an antidiarrheal agent approved by the Food and Drug Administration for the treatment of various forms of diarrhea in adults, including traveler’s diarrhea, irritable bowel syndrome associated with chronic diarrhea, and acute nonspecific diarrhea in patients 2 years of age and older, and reducing ileostomy output. The drug has, however, been shown to be toxic at therapeutic doses and causes serious cardiac adverse reactions, central nervous system (CNS) effects such as decreased level of consciousness, coordination abnormality, muscular hypertonia, miosis, respiratory depression, urinary retention, paralytic ileus, abdominal distension, and fecal impaction in infants and toddlers. Methods: We report an unusual case of suspected loperamide toxicity in a 22-day-old baby who presented with respiratory and CNS depression after consuming a single therapeutic dose of loperamide. Results: The neonate’s respiratory depression was attributed to ingestion of loperamide, prescribed by a local quack, as all other causes were ruled out. There was a significant improvement in the baby’s respiratory efforts after IV naloxone, an effective antidote. Conclusion: Special caution should be taken when administering loperamide to pediatric patients due to their greater variability in response. Loperamide is often given by local quacks as a nonprescription medicine for immediate relief, even to infants and toddlers, without complete knowledge about its potential side effects at therapeutic doses. To address this, it is imperative that strict measures should be taken.