Ventricular tachycardia associated with high-dose chronic loperamide use

Area of Science:

• Cardiology
• Pharmacology
• Gastroenterology

Background:

• Loperamide is an over-the-counter antidiarrheal medication.
• It acts on μ-opioid receptors in the gastrointestinal tract.
• Its potential for abuse and toxicity is considered low.

Observation:

• A patient developed cardiac pauses and ventricular tachycardia, requiring resuscitation and a pacemaker.
• She had a history of type 2 diabetes and chronic diarrhea.
• She reported daily use of 144 mg of loperamide for two years.

Findings:

• This is the first reported case of serious ventricular arrhythmia linked to long-term, high-dose loperamide use.
• Chronic loperamide overtreatment can lead to life-threatening cardiac arrhythmias.
• Ventricular arrhythmias associated with loperamide overdose have been previously documented.

Implications:

• Clinicians should consider loperamide toxicity in patients with unexplained cardiac arrhythmias.
• Long-term, high-dose use of over-the-counter medications can pose significant health risks.
• Awareness of potential cardiac toxicity from loperamide is crucial for patient safety.