Loperamide abuse and cardiotoxicity

Smith, Nichole A.; Sehring, Matthew; Chambers, Jefferson

doi:10.1080/20009666.2017.1361294

Cited by 5 publications

(5 citation statements)

References 3 publications

(7 reference statements)

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“…Concurrent use of loperamide with CYP3A4 inhibitors (e.g., itraconazole, grapefruit juice, omeprazole, tonic water and cimetidine) or CYP2C8 inhibitors (e.g., gemfibrozil) can increase its plasma levels as well, with recurrent ventricular tachycardia having been reported in a patient who was taking large recreational doses of both loperamide and the CYP3A4 inhibitor, famotidine [ 190 ]. Treatment of loperamide intoxication involves the use of naloxone, which may not be able to directly reverse loperamide cardiotoxic effects [ 191 , 192 ].…”

Section: Resultsmentioning

confidence: 99%

Abuse of Prescription Drugs in the Context of Novel Psychoactive Substances (NPS): A Systematic Review

et al. 2018

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Recently, a range of prescription and over-the-counter drugs have been reportedly used as Novel Psychoactive Substances (NPS), due to their potential for abuse resulting from their high dosage/idiosyncratic methods of self-administration. This paper provides a systematic review of the topic, focusing on a range of medications which have emerged as being used recreationally, either on their own or in combination with NPS. Among gabapentinoids, pregabalin may present with higher addictive liability levels than gabapentin, with pregabalin being mostly identified in the context of opioid, polydrug intake. For antidepressants, their dopaminergic, stimulant-like, bupropion activities may explain their recreational value and diversion from the therapeutic intended use. In some vulnerable clients, a high dosage of venlafaxine (‘baby ecstasy’) is ingested for recreational purposes, whilst the occurrence of a clinically-relevant withdrawal syndrome may be a significant issue for all venlafaxine-treated patients. Considering second generation antipsychotics, olanzapine appears to be ingested at very large dosages as an ‘ideal trip terminator’, whilst the immediate-release quetiapine formulation may possess proper abuse liability levels. Within the image- and performance- enhancing drugs (IPEDs) group, the beta-2 agonist clenbuterol (‘size zero pill’) is reported to be self-administered for aggressive slimming purposes. Finally, high/very high dosage ingestion of the antidiarrhoeal loperamide has shown recent increasing levels of popularity due to its central recreational, anti-withdrawal, opiatergic effects. The emerging abuse of prescription drugs within the context of a rapidly modifying drug scenario represents a challenge for psychiatry, public health and drug-control policies.

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Section: Resultsmentioning

confidence: 99%

Abuse of Prescription Drugs in the Context of Novel Psychoactive Substances (NPS): A Systematic Review

et al. 2018

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“…The potential for loperamide to be misused as a substance of abuse is even less recognised, with few reported cases linked to cardiotoxicity. 4 Evidence for causation is demonstrated in this case by the normal QTc interval prior to the loperamide addiction and the decreased QTc interval following reduction of loperamide intake. Furthermore, due to the family history of Stokes-Adams attacks, this may be a case of subclinical congenital long QT syndrome which was exacerbated by loperamide, as has been described in previous cases.…”

Section: Discussionmentioning

confidence: 70%

Loperamide: an emerging drug of abuse and cause of prolonged QTc

Whittaker

Newman

2021

Clinical Medicine

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“…Unfortunately, there seems to have been a steady rise in recreational abuse for its opioid-like effects in recent years [12]. The cardiac complications have ranged from often presenting as QRS widening, QTC prolongation, ventricular tachycardia, Torsade's de Pointes, or a Brugada-like syndrome [4,11,[13][14]. The Illinois Poison Center (IPC) took care of 137 cases of loperamide exposures from 2014 to 2016, out of which 18 overdosed for the purpose of abuse, withdrawal prevention, or withdrawal treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have reported misusers describing their experiences, like "lope highs" after large consumptions of the medicine as "better than any oxycodone" [8]. Unfortunately, high doses of loperamide have profound cardiotoxic effects, including serious dysrhythmias [1][2]11].…”

Section: Introductionmentioning

confidence: 99%

A Rising Concern of Loperamide Abuse: A Case Report on Resulting Cardiac Complications

Sapra

Bhandari

Gupta

et al. 2019

Cureus

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The purpose of our case report is to generate awareness among the providers about the rising abuse of loperamide, which is a readily available nonprescription medication for its opiate-like actions and the risk of severe cardiac complications as a consequence of the same. It is currently becoming a significant concern among the healthcare fraternity due to its increasing abuse owing to its opioid agonistic activity. Our patient was a 32-year-old female who presented to the ED with ventricular dysrhythmias and persistent, prolonged QT interval secondary to excessively high doses of over-the-counter (OTC) loperamide abuse. More and more cases of loperamide abuse and its cardiotoxic potential are being reported in the literature, highlighting the increasing incidence of this problem.

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Loperamide abuse and cardiotoxicity

Cited by 5 publications

References 3 publications

Abuse of Prescription Drugs in the Context of Novel Psychoactive Substances (NPS): A Systematic Review

Abuse of Prescription Drugs in the Context of Novel Psychoactive Substances (NPS): A Systematic Review

Loperamide: an emerging drug of abuse and cause of prolonged QTc

A Rising Concern of Loperamide Abuse: A Case Report on Resulting Cardiac Complications

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