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Lookup NU author(s): Dr Catherine Napier,
Dr Earn Gan,
Professor Simon PearceORCiD
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).
© 2016 BMJ Publishing Group. Loperamide is the most commonly used antidiarrhoeal medication in the UK. We report a serious and hitherto undocumented adverse effect of chronic use in a 45-year-old man with inflammatory bowel disease. He presented to the endocrine clinic with fatigue and low libido; biochemical assessment revealed hypogonadism and adrenal insufficiency without any elevated adrenocorticotropic hormone. When symptoms allowed, loperamide was reduced and a short synacthen test (SST) showed a 'clear pass' with a normal peak cortisol of 833 nmol/L. Later, worsening diarrhoea necessitated an escalation in loperamide use again. While taking a daily dose of 15-20 mg (recommended daily maximum 16 mg) reassessment revealed a fall in peak cortisol on SST to 483 nmol/L, a subnormal response. Clinicians should exercise caution when relying on loperamide to manage their patients' chronic diarrhoea and remain mindful of the possibility of drug-induced life-threatening adrenal insufficiency.
Author(s): Napier C, Gan EH, Pearce SHS
Publication type: Article
Publication status: Published
Journal: BMJ Case Reports
Online publication date: 28/09/2016
Acceptance date: 09/09/2016
Date deposited: 24/04/2017
ISSN (print): 1757-790X
Publisher: BMJ Publishing Group
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