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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)....

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Autores principales: Guinchat, Vincent, Ansermot, Nicolas, Ing Lorenzini, Kuntheavy, Politis, Dimitri, Daali, Youssef, Eap, Chin B., Crettol, Séverine
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
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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.
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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
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