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

  • Enrica Di Rosa (a1) and Antonio E. Di Rosa (a2)

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.


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

Corresponding author
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:,
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Acta Neuropsychiatrica
  • ISSN: 0924-2708
  • EISSN: 1601-5215
  • URL: /core/journals/acta-neuropsychiatrica
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