[Torsade de pointes following repeated massive loperamide ingestions]
Linda Myllymäki1, Jenny Westerbergh1, Håkan Carlsson2
1Giftinformationscentralen - Stockholm, Sweden Giftinformationscentralen - Stockholm, Sweden.
Lakartidningen
|February 5, 2020
Summary
High doses of the anti-diarrheal drug loperamide can cause dangerous heart problems. This case report highlights severe cardiovascular symptoms, including torsade de pointes, from massive loperamide intake.
Area of Science:
- Pharmacology
- Cardiology
- Toxicology
Background:
- Loperamide, an anti-diarrheal, is a mu-opioid agonist.
- Standard doses result in poor systemic bioavailability.
- High doses increase bioavailability by saturating P-glycoprotein and first-pass metabolism.
Observation:
- Recent reports link massive loperamide doses to life-threatening cardiovascular symptoms.
- A patient presented with syncope, wide QRS complexes, and prolonged QTc intervals.
- The patient experienced torsade de pointes during hospitalization.
Findings:
- Massive loperamide intake can lead to central nervous system opioid effects.
- Overdosing on loperamide can cause severe systemic side effects.
- Cardiac arrhythmias like torsade de pointes are associated with extreme loperamide use.
Implications:
- Clinicians should be aware of potential cardiac toxicity with high-dose loperamide.
- Loperamide abuse may lead to serious cardiovascular events.
- Further research is needed to understand the mechanisms of loperamide-induced cardiotoxicity.
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