“Bottoms living on Imodium, is it Safe?”
One of my friends asked that I write a section called “bottoms living on Imodium, is it safe?” In short, yes! But as with all things, in moderation.
One of the most common reasons for recreational Imodium use is for long or repeated sessions where the user is trying to keep the rectum clear for a prolonged period of time- “to keep the douche“. Different dosing strategies are used, and generally taking the recommended dose of 8 mg or less per day for a short period of time is considered safe.
Because each of our GI tracts are different and uniquely impacted by our diets, medications, supplements, and mental health among other factors, the optimal timing and dosing for this medication will vary from person to person. Using the drug for sex can be complicated by ongoing or chronic bowel issues, like constipation, diarrhea, or both. When Imodium use is for bowel issues (rather than sex exclusively), it is helpful to identify the underlying cause, and a healthcare provider can be helpful in identifying whether symptoms are related to diet, medication, supplements, mental health/stress, medical issues, infections, or other causes. When used to treat GI conditions, like irritable bowel syndrome (IBS), the dose may be higher than 8 mg under the direction of a healthcare provider. For acute (new, relatively intense) diarrhea, Imodium can be helpful, but if it is caused by an infection, Imodium can worsen the disease course. It is not recommended for diarrhea lasting more than 2 days or diarrhea associated with a fever- in which case a trip to your favorite PA (or other healthcare provider) is in order.
Imodium (loperamide) is an over-the-counter antidiarrheal medication. It is technically an opioid medication, but at recommended doses, it only impacts the gastrointestinal tract by slowing how digested food moves through the intestines.
The recommended dose is 4 milligrams (mg) which is 2 tablets. This may be followed by another 2 mg (1 tablet) after an unformed stool, and that may be repeated one additional time each day for a daily maximum of 8 mg or 4 tablets. At this dose there are very few side effects, most commonly gas, abdominal cramping, and nausea. Drug concentrations peak at 4-5 hours and then remain for several additional hours after taking the medication. Here’s a resource for more technical information.
Imodium is generally a very safe drug when used as directed, but at high concentrations the drug can accumulate in the body where it can impact the brain causing opioid effects (happiness, relaxation, drowsiness, slowed breathing), but more importantly, can cause significant major, potentially fatal injury to the heart.
There’s no clear threshold for how much is too much, but most reports of heart injury are at doses of 60-400 mg (or 30-200 tablets) per day. Most overdose cases are in attempt to reach the opioid effects rather than for sex. These opioid effects, which can be worsened by other drugs with similar effects, can be dangerous and are reversible with naltrexone (Narcan). Whenever naltrexone is administered it is best to seek medical attention; sometimes people choose not to for fear of repercussions, but keep in mind that Imodium is a legal, over-the-counter medication.
Ongoing use for prolonged periods isn’t recommended by the manufacturer, and I am unaware of any rigorous trials evaluating the effects of ongoing use. Personally, I’m unaware of any cases where Imodium became ineffective or where someone became dependent on the medications (this does not mean that it doesn’t ever happen).
Sahi N, Nguyen R, Santos C. Loperamide. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2023. PMID: 32491808.
Upadhyay A, Bodar V, Malekzadegan M, Singh S, Frumkin W, Mangla A, Doshi K. Loperamide induced life threatening ventricular arrhythmia. Case Reports in Cardiology. 2016 Jul 28;2016.
RectalRockstar 