Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-10T13:50:18.548Z Has data issue: false hasContentIssue false
  • English
  • Français

Loperamide overdose-induced catatonia: potential role of brain opioid system and P-glycoprotein

Published online by Cambridge University Press:  08 October 2013

Enrica Di Rosa  and
Antonio E. Di Rosa
Enrica Di Rosa*
Affiliation:
Department of Clinical and Experimental Medicine, University of Messina, via Consolare Valeria, 1, 98125, Messina, Italy
Antonio E. Di Rosa
Affiliation:
Department of Neurosciences, University of Messina, via Consolare Valeria, 1, 98125, Messina, Italy
*
Enrica Di Rosa, Department of Clinical and Experimental Medicine and Pharmacology, University of Messina, Policlinico Universitario, via Consolare Valeria, 1, 98125 Messina, Italy. Tel: +00393333992601; Fax: +0039090695136; E-mails: edirosa@unime.it, enricadirosa@tiscali.it
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Catatonic features are observed in several psychiatric illnesses but can also be found following substance misuse. Loperamide is an anti-diarrhoeal medication that acts on opioid receptors in the intestine, reducing peristalsis. It is normally unable to pass through the intestinal wall or the blood–brain barrier; however, high dosages can in fact induce the effects on the central nervous system.

Case report

We describe the case of a 20-year-old man who presented with severe catatonia following excessive intake of loperamide, fully remitted with lorazepam.

Conclusion

We speculate on a possible increase of loperamide's bioavailability after overdose owing to reduced expression and functioning of P-glycoprotein.

Keywords

catatonialoperamideopioid side effectsP-glycoprotein
Type
Case Report
Information
Acta Neuropsychiatrica , Volume 26 , Issue 1 , February 2014 , pp. 58 - 60
Copyright
Copyright © Scandinavian College of Neuropsychopharmacology 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Weder, ND, Muralee, S, Penland, H, Tampi, RR. Catatonia: a review. Ann Clin Psychiatry 2008;20:97–107.Google Scholar
2.Rewal, N, Amer, S, Gustafsson, LL, Allvin, R. Present state of extradural and intrathecal opioid analgesia in Sweden. Br J Anaesth 1987;59:791–799.CrossRefGoogle Scholar
3.Duggal, HS, Singh, I. Drug-induced catatonia. Drugs Today 2005;41:599–607.CrossRefGoogle ScholarPubMed
4.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th edn.Washington, DC: American Psychiatric Association, 1994.Google Scholar
5.Baker, DE. Loperamide: a pharmacological review. Rev Gastroenterol Disord 2007;7(Suppl. 3):S11–S18.Google Scholar
6.Thuerauf, N, Fromm, MF. The role of the transporter P-glycoprotein for disposition and effects of centrally acting drugs and for the pathogenesis of CNS disease. Eur Arch Psychiatry Clin Neurosci 2006;256:281–286.CrossRefGoogle Scholar
7.Friedli, G, Haenggelli, CA. Loperamide overdose managed by naloxone. Lancet 1980;1:1413.Google Scholar
8.Engquist, A, Jorgensen, BC, Andersen, HB. Catatonia after epidural morphine. Acta Anaesthesiol Scand 1981;25:445–446.CrossRefGoogle ScholarPubMed
9.Vandenbossche, J, Huisman, M, Xu, Y, Sanderson-Bongiovanni, D, Soons, P. Loperamide and P-glycoprotein inhibition: assessment of the clinical relevance. J Pharm Pharmacol 2010;62:401–412.Google Scholar
10.Litovitz, T, Clancy, C, Korberly, B, Temple, AR, Mann, KV. Surveillance of loperamide ingestions: an analysis of 216 poison center reports. J Toxicol Clin Toxicol 1997;35:11–19.Google Scholar
11.Rosebush, PI, Mazurek, MF. Catatonia and its treatment. Schizophr Bull 2010;36:239–242.Google Scholar
12.Gheuens, S, Michotte, A, Flamez, A, De Keyser, J. Delayed akinetic catatonic mutism following methadone overdose. Neurotoxicology 2010;31:762–764.Google Scholar
13.Huang, SS, Jou, SH, Chiu, NY. Catatonia associated with coadministration of tramadol and meperidine. J Formos Med Assoc 2007;106:323–326.Google ScholarPubMed