Loperamide-Induced Torsades de Pointes: A Case Series

Area of Science:

• Cardiology
• Toxicology
• Emergency Medicine

Background:

• Loperamide, an accessible antidiarrheal, poses life-threatening risks at high doses.
• Substance abuse disorder (SUD) and depression are common comorbidities in loperamide toxicity cases.

Observation:

• Two case reports detail patients with SUD presenting with severe cardiac events after high loperamide ingestion.
• Both patients exhibited significant ECG abnormalities, including prolonged QTc intervals and Torsades de Pointes (TdP).

Findings:

• Aggressive treatment with sodium bicarbonate, magnesium, and isoproterenol was initiated for both patients.
• Despite initial TdP, both patients were discharged in stable condition after intensive monitoring and treatment.

Implications:

• Emergency physicians must maintain a high index of suspicion for loperamide toxicity in patients with cardiac emergencies and SUD.
• Prompt ECG abnormality treatment, medical toxicology consultation, and hospital admission are crucial for managing loperamide toxicity.