Comment by DanBC | Hacker News Reader

Comment by DanBC | Hacker News Reader

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> Some randos on the internet believe that you could consume a bottle of loperamide and overcome that inability to get into the brain. In theory that’s true (since the brain barrier is actively pumping it back out and there’s gotta be a limit to that rejection), but I don’t think it’s worked out in practice other than causing massive constipation.

It's a medication that gets stolen by drug users which is a bit frustrating if it's not working for them.

BNF and Department of Health (England) don't describe addiction to loperamide, but do describe its use as an adjunctive treatment for people trying to come off opioids, which suggests it's not that problematic: https://bnf.nice.org.uk/treatment-summary/substance-dependen...

https://assets.publishing.service.gov.uk/government/uploads/...

> Prescribing symptomatically can reduce some of the physical effects of withdrawal. There is no systematic evidence that any of these medicines work to improve outcome but they may be useful for the clinician in situations where it is not possible to prescribe effective opioid substitution. Particular care is needed concerning the risks of polypharmacy and ensuring appropriate supervision and support in such cases.

> •Diarrhoea – loperamide 4mg immediately followed by 2mg after each loose stool for up to five days; usual dose 6-8mg daily, maximum 16mg daily.

> BNF and Department of Health (England) don't describe addiction to loperamide, but do describe its use as an adjunctive treatment for people trying to come off opioids, which suggests it's not that problematic

As someone who suffers from IBS and takes loperamide regularly, while its not necessarily an addiction, I see forums of people (especially on /r/ibs) saying that it causes a dependency. I saw posts where people kept upping the dose until it got to a point where it doesnt work anymore and you would have to increasingly take larger amounts to have the same effect. Heck some take as many as 3 after every meal. I cant imagine doing that.

I try to avoid doing this and luckily I can get away with one every few days but I dread the day I have to be in that situation.

One thing I noticed is that - it gives me incredible mental boost a day after taking it. It just makes me feel normal and that to me is a 'boost'.

> One thing I noticed is that - it gives me incredible mental boost a day after taking it. It just makes me feel normal and that to me is a 'boost'.

I've read that loperamide doesn't just quell bowel problems with opioid withdrawal, but that it lessens cognitive symptoms, as well.

Sounds like there might be some active metabolites, or that peripheral opioid receptor activation can affect cognition.

Yea atleast from personal experience with n=1, I think it does affect cognition and honestly I am glad it works that way and I discovered it lol. On other days when IBS is in full effect, I dread doing any work and have zero focus.

after an accident ~15 years ago, I was discharged after 6 months on 120mg of Oxycontin daily (40mg 3x a day) After being frustrated being tethered to the oxy bottle, I went cold turkey. The first thing that happened after the withdrawal symptoms subsided was I found I had chronic diarrhea. After years with my doctor trying different things, I found that the symptoms could be managed with about 16mg of loperamide. That was great for a while, until the FDA restricted the bottle size. At that point I could no longer buy enough over the counter, so I now have my doctor prescribing it for me. Unfortunately 16mg a day is the largest amount they can prescribe (IFAIK) so if it gets worse, I'll have to figure out another solution.

I'm not sure why this happened, but my suspicion is that while hospitalized I was infected by MRSA, and to try to get rid of it they were dumping some of the more toxic anti-bacterials into me to get rid of the MRSA (which took a year and a half to get rid of.)

Wow, cant imagine being in your situation. I would say try to ease yourself into lowering your dose slowly. I am not sure if its even possible with your situation but with IBS I try to control everything else including stress, food and sleep. I take loperamide if those dont work and it allows me to reset myself into being normal for sometime, that way I can retry. I try to go as long as I can without one and see if I can push myself. But I dont get too far due to work stress anyway.

Honestly the whole thing about people abusing it and FDA clamping down works against normal people who are genuinely using it.

I started an opiate taper at 40mg loperamide a day and while I didn't feel euphoria it definitely had a strange, almost dissociative high. On other forums people report therapeutic effects up in the 100mg range, but ymmv

Starting at 40mg - thats sounds really high. I wonder whats the effect on the gut. Doesnt the food get backed up a lot which leads really really bad constipation or is that not as pronounced.

It was a long time ago; I think I mixed in miralax. I don't remember any gut issues.

40, 38, 36, ... -> freedom

There’s a high chance of rebound diarrhoea when coming off opiates/withdrawing. Standard dose Loperamide should work for that.

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