Dysrhythmias with Loperamide Used for Opioid Withdrawal

Vithalani, Nicki; Heron, Christopher; Rao, Ravishankar E.; Cardell, Anthony F.; Stephens, Mark B.

doi:10.3122/jabfm.2017.06.170066

Cited by 9 publications

(3 citation statements)

References 2 publications

(2 reference statements)

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“…Many cases in the literature have reported ventricular arrhythmias and torsade de pointes, which resolved after discontinuing loperamide therapy [6,7]. In a small series of five patients, high dose chronic use of loperamide was shown to be associated with QRS and QTc prolongation, and a variety of events with ventricular dysrhythmias [8].…”

Section: Discussionmentioning

confidence: 99%

Cardiac Dysrhythmia Associated With Opioid Toxicity

Rawala

Gulati

Rizvi

2020

Cureus

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Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder involving abnormal motility. The patients are commonly started on symptom control management for IBSdiarrhea subtype by prescribing antimotility agents, usually having opioid agonist activity, and newer medications have been emerging for this as well. Patients sometimes self-medicate themselves to exceedingly high doses of these medications to achieve symptoms control. There are only a few cases of opioid-induced arrhythmia in the literature, primarily loperamide being used as a drug substitute by substance abusers. Still, it has been rarely reported to cause arrhythmia in a patient with IBS. We present a case of a 33-year-old female with a past medical history of hypertension and depression who presented to the emergency department for evaluation of syncope. She had wide complex tachycardia on electrocardiogram (EKG) with prolonged rate-corrected QT interval (QTc). Her medications, including eluxadoline, Lomotil, and loperamide, were held and she was discharged on mexiletine with normal QTc. She did not have any more incidences of arrhythmia. This case highlights the importance of not overdosing on opioid agonist medications prescribed to treat IBS as these can lead to potentially fatal complications. Physicians have to be judicious in promptly determining that the cause of arrhythmia can also be over-the-counter (OTC) medications.

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Section: Discussionmentioning

confidence: 99%

Cardiac Dysrhythmia Associated With Opioid Toxicity

Rawala

Gulati

Rizvi

2020

Cureus

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“…Current literature confirms that only excessively high doses can cause serious cardiac side-effects and potential death. [24][25][26][27][28][29][30][31] This study addressed the safety of loperamide over a short period of time and during the study development no serious adverse events were reported. Despite differences in study design, this finding is comparable with other treatment approaches used for opioid detoxification 17,18,32,33 and, when considered together with the finding that no instances were reported of additional requests for either medication, suggests that this protocol is not only safe, but also well-tolerated.…”

Section: Safetymentioning

confidence: 99%

Novel opioid detoxification using loperamide and P‐glycoprotein inhibitor

Garhy¹,

Williams²,

Mohan³

et al. 2019

Prog Neurol Psychiatry

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Opioids were responsible for 76% of substancerelated death in 2015 and only one in six people received effective treatment for their substance use disorder globally due to unavailability of services in 2016. Here, Al Garhy et al. describe the characteristics of inpatients receiving loperamide with a P‐glycoprotein inhibitor for medically‐supported detoxification at Sheikh Khalifa Medical City Hospital and provide preliminary evidence that loperamide and omeprazole, two inexpensive over‐the‐counter medications, can effectively and safely reduce the full spectrum of opioid withdrawal manifestations in male patients.

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“…Finally, a case report in this issue is designed to grab the attention of those clinicians unaware of the current widespread use of loperamide by opioid addicts to treat withdrawal symptoms, sometimes to disastrous effect. Vithalani et al 13 report that major dysrhythmias can result.…”

Section: A New Type Of Pain Consult Service Opioids Used For Low Bacmentioning

confidence: 99%

Multiple Practical Facts and Ideas to Improve Family Medicine Care

Bowman¹,

Seehusen

Neale³

2017

J Am Board Fam Med

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Seconds count in a study on the best electronic health note format to reduce medical record charting time and increase accuracy. Directly observed family physician work is compared with Current Procedural Terminology (CPT) coding examples and notably under-recognized. This issue contains articles from single practices that that implemented new methods of care and other reports on practice innovations that can be more broadly implemented. We have articles on opioid medication use for acute low back pain in primary care, an electronic chronic pain consult service, a key question to identify potential opioid misuse risk, and newly implemented screening for other substances of abuse. Omissions (or gaps) in care are also highlighted: from the common types of omissions identified by primary care clinicians, self-reported low levels of substance use screening by family medicine prenatal care providers, and inadequate and inadequately available hospital discharge summaries. In addition, the most important alarm symptoms for a cancer diagnosis are reported. Seconds Count-How to Improve Electronic Health Records, and Thus Physicians' LivesIn the category of useful and practical, and some potential relief from the electronic health record (EHR) frustrations blamed for physician burnout, Belden et al 1 compared different EHR note formats (including some novel prototypes) by several excellent methods (audio, computer-screen activity, eye tracking, and field notes). The authors measured the actual time-on-task, as well as accuracy and effort. A reminder is that the few seconds' difference between the formats can add up quickly across many charts and visits. Some notes were collapsible in design. The proposed note prototypes performed better than the traditional Subjective, Objective, Assessment, Plan (SOAP) note format for speed, accuracy, and usability. It is worth looking at the appendices to see the actual note formats. Here's to having many individuals show this article to their EHR vendor! Care Innovation Reports from Single Family Medicine OfficesIn our lead article, Schwartz et al 2 discusses incorporating pharmacogenetics into a family practice for making medication decisions. A pharmacist completed medication reconciliation with patients taking a large number of medications and reviewed the completed pharmacogenetic testing, then made recommendations to the physician for medication changes. Drug-gene interactions were found a quarter of the time. In practice, I (MAB) have received pharmacogenetic reports ordered by psychiatrists for patients who have tried many different antidepressants without sufficient success. The reports seem to be useful for medication selection, but the full outcomes of pharmacogenetics on patient care are far from known. Axten et al 3 report on a novel wellness group visit model for obesity. A single family physician and collaborating dietician report on the success of this model, finding that much of the weight loss was sustained through 3 years of followup. See their excellent helpful hint...

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Dysrhythmias with Loperamide Used for Opioid Withdrawal

Cited by 9 publications

References 2 publications

Cardiac Dysrhythmia Associated With Opioid Toxicity

Cardiac Dysrhythmia Associated With Opioid Toxicity

Novel opioid detoxification using loperamide and P‐glycoprotein inhibitor

Multiple Practical Facts and Ideas to Improve Family Medicine Care

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