Cargando…
Case Report: Opioid Use Disorder Associated With Low/Moderate Dose of Loperamide in an Intellectual Disability Patient With CYP3A and P-Glycoprotein Reduced Activity
Loperamide is an over-the-counter antidiarrheal for which increasing cases of abuse or misuse are described. We report the onset of opioid use disorder associated with low to moderate doses of loperamide in an intellectual disability patient without previous history of substance use disorder (SUD)....
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9261480/ https://www.ncbi.nlm.nih.gov/pubmed/35815036 http://dx.doi.org/10.3389/fpsyt.2022.910684 |
_version_ | 1784742287175057408 |
---|---|
author | Guinchat, Vincent Ansermot, Nicolas Ing Lorenzini, Kuntheavy Politis, Dimitri Daali, Youssef Eap, Chin B. Crettol, Séverine |
author_facet | Guinchat, Vincent Ansermot, Nicolas Ing Lorenzini, Kuntheavy Politis, Dimitri Daali, Youssef Eap, Chin B. Crettol, Séverine |
author_sort | Guinchat, Vincent |
collection | PubMed |
description | Loperamide is an over-the-counter antidiarrheal for which increasing cases of abuse or misuse are described. We report the onset of opioid use disorder associated with low to moderate doses of loperamide in an intellectual disability patient without previous history of substance use disorder (SUD). Our patient presented strongly reduced activities of CYP3A and P-glycoprotein, which are mainly involved in loperamide metabolism and transport. We suggest that this led to an increase in bioavailability, systemic exposure, and brain penetration thus allowing loperamide to act on the central nervous system and contributing to the development of SUD. Slow release oral morphine (SROM) was chosen as opioid agonist treatment, which successfully contained loperamide use and globally improved her clinical condition. This situation highlights the need for caution and awareness when prescribing loperamide, particularly in vulnerable patients with few cognitive resources to understand the risks of self-medication and little insight into its effects. |
format | Online Article Text |
id | pubmed-9261480 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-92614802022-07-08 Case Report: Opioid Use Disorder Associated With Low/Moderate Dose of Loperamide in an Intellectual Disability Patient With CYP3A and P-Glycoprotein Reduced Activity Guinchat, Vincent Ansermot, Nicolas Ing Lorenzini, Kuntheavy Politis, Dimitri Daali, Youssef Eap, Chin B. Crettol, Séverine Front Psychiatry Psychiatry Loperamide is an over-the-counter antidiarrheal for which increasing cases of abuse or misuse are described. We report the onset of opioid use disorder associated with low to moderate doses of loperamide in an intellectual disability patient without previous history of substance use disorder (SUD). Our patient presented strongly reduced activities of CYP3A and P-glycoprotein, which are mainly involved in loperamide metabolism and transport. We suggest that this led to an increase in bioavailability, systemic exposure, and brain penetration thus allowing loperamide to act on the central nervous system and contributing to the development of SUD. Slow release oral morphine (SROM) was chosen as opioid agonist treatment, which successfully contained loperamide use and globally improved her clinical condition. This situation highlights the need for caution and awareness when prescribing loperamide, particularly in vulnerable patients with few cognitive resources to understand the risks of self-medication and little insight into its effects. Frontiers Media S.A. 2022-06-23 /pmc/articles/PMC9261480/ /pubmed/35815036 http://dx.doi.org/10.3389/fpsyt.2022.910684 Text en Copyright © 2022 Guinchat, Ansermot, Ing Lorenzini, Politis, Daali, Eap and Crettol. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Psychiatry Guinchat, Vincent Ansermot, Nicolas Ing Lorenzini, Kuntheavy Politis, Dimitri Daali, Youssef Eap, Chin B. Crettol, Séverine Case Report: Opioid Use Disorder Associated With Low/Moderate Dose of Loperamide in an Intellectual Disability Patient With CYP3A and P-Glycoprotein Reduced Activity |
title | Case Report: Opioid Use Disorder Associated With Low/Moderate Dose of Loperamide in an Intellectual Disability Patient With CYP3A and P-Glycoprotein Reduced Activity |
title_full | Case Report: Opioid Use Disorder Associated With Low/Moderate Dose of Loperamide in an Intellectual Disability Patient With CYP3A and P-Glycoprotein Reduced Activity |
title_fullStr | Case Report: Opioid Use Disorder Associated With Low/Moderate Dose of Loperamide in an Intellectual Disability Patient With CYP3A and P-Glycoprotein Reduced Activity |
title_full_unstemmed | Case Report: Opioid Use Disorder Associated With Low/Moderate Dose of Loperamide in an Intellectual Disability Patient With CYP3A and P-Glycoprotein Reduced Activity |
title_short | Case Report: Opioid Use Disorder Associated With Low/Moderate Dose of Loperamide in an Intellectual Disability Patient With CYP3A and P-Glycoprotein Reduced Activity |
title_sort | case report: opioid use disorder associated with low/moderate dose of loperamide in an intellectual disability patient with cyp3a and p-glycoprotein reduced activity |
topic | Psychiatry |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9261480/ https://www.ncbi.nlm.nih.gov/pubmed/35815036 http://dx.doi.org/10.3389/fpsyt.2022.910684 |
work_keys_str_mv | AT guinchatvincent casereportopioidusedisorderassociatedwithlowmoderatedoseofloperamideinanintellectualdisabilitypatientwithcyp3aandpglycoproteinreducedactivity AT ansermotnicolas casereportopioidusedisorderassociatedwithlowmoderatedoseofloperamideinanintellectualdisabilitypatientwithcyp3aandpglycoproteinreducedactivity AT inglorenzinikuntheavy casereportopioidusedisorderassociatedwithlowmoderatedoseofloperamideinanintellectualdisabilitypatientwithcyp3aandpglycoproteinreducedactivity AT politisdimitri casereportopioidusedisorderassociatedwithlowmoderatedoseofloperamideinanintellectualdisabilitypatientwithcyp3aandpglycoproteinreducedactivity AT daaliyoussef casereportopioidusedisorderassociatedwithlowmoderatedoseofloperamideinanintellectualdisabilitypatientwithcyp3aandpglycoproteinreducedactivity AT eapchinb casereportopioidusedisorderassociatedwithlowmoderatedoseofloperamideinanintellectualdisabilitypatientwithcyp3aandpglycoproteinreducedactivity AT crettolseverine casereportopioidusedisorderassociatedwithlowmoderatedoseofloperamideinanintellectualdisabilitypatientwithcyp3aandpglycoproteinreducedactivity |