The Long QT Teaser: Loperamide Abuse

Enakpene, Evbu; Riaz, Irbaz Bin; Shirazi, Farshad; Raz, Yuval; Indik, Julia H.

doi:10.1016/j.amjmed.2015.05.019

Cited by 54 publications

(45 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Because of this, the FDA released a warning in 2016 regarding its potential for negative cardiac side effects . Since the earliest case reports in 2014, several case reports have since described the various cardiac manifestations induced by loperamide abuse . While the exact mechanisms are not completely understood, the various cardiac manifestations are suspected to be due to lopermide's effects primarily on hERG/Ikr potassium channel and cardiac sodium channels, which mimic the effect of Vaughan–Williams Class III and Class IA antiarrhythmic agents, respectively .…”

Section: Discussionmentioning

confidence: 99%

Wide complex tachycardia and cardiomyopathy: What would you do?

Ahmed

Freeland

Steinberg

et al. 2018

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Wide complex tachycardia and cardiomyopathy: What would you do?

Ahmed

Freeland

Steinberg

et al. 2018

Cardiovasc electrophysiol

View full text Add to dashboard Cite

“…An overdrive pacemaker was used to achieve the same strategy. Lidocaine was added to stabilize the ventricular membrane [14,15]. After the initial usage during a VF arrest, amiodarone use was avoided because of the risk of QT prolongation.…”

Section: Discussionmentioning

confidence: 99%

Ventricular fibrillation due to overdose of loperamide, the “poor man’s methadone”

Salama

Levin

Jha

et al. 2017

Journal of Community Hospital Internal Medicine Perspectives

View full text Add to dashboard Cite

Loperamide is an over-the-counter antidiarrheal agent that is considered by many patients to be safe, but has been used as a drug of abuse due to its opioid properties. However, cardiotoxicity has been reported, prompting the FDA to release a warning regarding the arrhythmogenic potential of loperamide. We present a case of a 38-year-old female presenting with cardiac arrest thought to be secondary to abuse of the loperamide that she was using to alleviate the heroin withdrawal symptoms. Cardiac ischemia and other drug toxicities were ruled out. Loperamide induces QTc prolongation and cardiac dysrhythmias. She had recurrent ventricular arrhythmias with multiple cardiac arrests. The persistence of the cardiotoxicity for a longer duration than previously reported in the literature is unique in this clinical presentation. We also highlight the potential mechanisms for loperamide cardiotoxicity and its challenging management. Abbreviations: ACLS: Advanced cardiac life support; GI: Gastrointestinal

show abstract

“…Several published cases report the onset of ventricular arrhythmias after administration of high doses of loperamide [4][5][6][7]. We describe a 32 year-old woman who experienced TdP after excessive use of loperamide to manage symptoms of opioid withdrawal.…”

Section: Resultsmentioning

confidence: 99%

“…Several cases have been reported that implicate loperamide use as the cause of life-threatening ventricular arrhythmias [4][5][6][7]. A case series describes five patients who experienced electrophysiologic abnormalities after overuse of loperamide in which most of the patients were taking greater than 100 mg of loperamide daily.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Torsades de Pointes Secondary to Excessive Loperamide Use

Tuyl¹,

Brock²,

Campbell³

et al. 2016

JPP

View full text Add to dashboard Cite

Loperamide is a common, over-the-counter, antidiarrheal medication that has been implicated in cases of ventricular tachycardia. A 32 year-old female patient with a history of opioid abuse and no prior history of cardiovascular disease experienced Torsades de pointes. An electrocardiogram at the time of hospital presentation revealed a prolonged QT interval at 636 msec. Diagnostic evaluation was unremarkable for any underlying cardiovascular pathology. Further investigation revealed the patient had been taking 30-40 loperamide 2 mg tablets oral daily for 2 weeks prior to the onset of Torsades de pointes. At high doses, loperamide may prolong the QT interval through antagonism of the human ether-a-go-go potassium current, thus increasing the risk of ventricular arrhythmias. Clinicians should be cautious with administration of high doses of loperamide to all patients, especially patients at high risk for QT interval prolongation.

show abstract

The Long QT Teaser: Loperamide Abuse

Cited by 54 publications

References 6 publications

Wide complex tachycardia and cardiomyopathy: What would you do?

Wide complex tachycardia and cardiomyopathy: What would you do?

Ventricular fibrillation due to overdose of loperamide, the “poor man’s methadone”

Torsades de Pointes Secondary to Excessive Loperamide Use

Contact Info

Product

Resources

About