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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
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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 

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