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Clinical Review: Loperamide Toxicity.

Peter E Wu1, David N Juurlink2

  • 1Department of Medicine, University Health Network, Toronto, Ontario, Canada; Division of Clinical Pharmacology and Toxicology and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Annals of Emergency Medicine
|May 17, 2017
PubMed
Summary
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Loperamide misuse can cause life-threatening cardiac toxicity, even in young individuals. Prompt recognition and advanced cardiac life support are crucial for survival and managing potential opioid use disorder.

Area of Science:

  • Cardiology
  • Clinical Toxicology
  • Pharmacology

Background:

  • Loperamide, an over-the-counter opioid, is commonly used for diarrhea.
  • Increasing misuse of loperamide at high doses for euphoric effects or opioid withdrawal is reported.
  • Loperamide-induced cardiac toxicity is a new, life-threatening clinical syndrome.

Purpose of the Study:

  • To describe the clinical presentation and management of loperamide-induced cardiac toxicity.
  • To highlight the risks associated with high-dose loperamide misuse.
  • To emphasize the importance of recognizing cardiac complications in loperamide toxicity.

Main Methods:

  • Case series review of patients presenting with loperamide toxicity.
  • Electrocardiogram (ECG) analysis for characteristic abnormalities.

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  • Review of treatment strategies including advanced cardiac life support and novel interventions.

    • Main Results:

    • Patients often young, presenting with cardiac arrest or syncope.
    • Common ECG findings include QT-interval prolongation, QRS widening, and ventricular dysrhythmias.
    • Conventional opioid toxicity symptoms may coexist.

    Conclusions:

    • Loperamide toxicity can lead to severe cardiac events requiring intensive management.
    • Treatment involves advanced cardiac life support, supportive care, and potentially ECMO or pacing.
    • Addressing underlying opioid use disorder is essential for survivors.