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Torsades de pointes with high-dose loperamide.

Patrick M Kozak¹, Amanda E Harris¹, John A McPherson¹

¹Department of Internal Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, D-3100 Medical Center North, Nashville, TN.

Journal of Electrocardiology

|January 23, 2017

Summary

High-dose loperamide use can cause dangerous heart rhythm problems like torsades de pointes, even in individuals without prior heart conditions. Regulations on over-the-counter loperamide purchases may be necessary to prevent misuse and serious cardiac events.

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Area of Science:

Cardiology
Clinical Pharmacology
Toxicology

Background:

Loperamide is an over-the-counter medication primarily used for diarrhea.
Misuse of loperamide at high doses for self-medication of pain is an emerging concern.

Observation:

A 41-year-old male presented with torsades de pointes, a life-threatening cardiac arrhythmia.
The patient was consuming over 100mg of loperamide daily to manage chronic pain.
Extensive cardiac workup, including angiography, MRI, and genetic testing, ruled out underlying cardiac or genetic predispositions.

Findings:

High-dose loperamide ingestion can lead to significant QTc prolongation and torsades de pointes.
Individuals without pre-existing cardiac abnormalities are susceptible to these severe cardiac events.

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Implications:

This case highlights the critical risk of cardiac toxicity associated with supra-therapeutic loperamide use.
Consideration should be given to regulating the retail quantity of loperamide, similar to other potentially misused over-the-counter drugs.
Increased awareness among healthcare providers and the public regarding loperamide misuse and its cardiac dangers is warranted.