Loperamide-induced hypopituitarism. (28th September 2016)

• Record Type: Journal Article
• Authors: Napier, Catherine; Gan, Earn H; Pearce, Simon H S
• Is Part Of: BMJ case reports. Volume 2016
• Publication Date: 2016-09-28
• Subjects: Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2016-216384
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : 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.