Cardiac Dysrhythmia Associated With Opioid Toxicity
Muhammad Shabbir Rawala1, Rajat Gulati2, Syed Rizvi3
1Internal Medicine, Charleston Area Medical Center, Charleston, USA.
Cureus
|May 30, 2020
Summary
Patients with Irritable Bowel Syndrome (IBS) can develop serious heart rhythm problems from high doses of prescribed antimotility medications. This case highlights the risk of opioid agonist overdose in IBS patients, emphasizing careful prescribing and monitoring.
Area of Science:
- Cardiology
- Gastroenterology
- Clinical Pharmacology
Background:
- Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterized by abnormal gut motility.
- Antimotility agents with opioid agonist activity are commonly prescribed for IBS-diarrhea, with some patients self-medicating to high doses.
- Opioid-induced arrhythmia is rarely reported in IBS patients, with most cases involving loperamide abuse.
Observation:
- A 33-year-old female with hypertension and depression presented with syncope.
- Electrocardiogram (EKG) revealed wide complex tachycardia and a prolonged rate-corrected QT interval (QTc).
- Her IBS medications (eluxadoline, Lomotil, loperamide) were discontinued.
Findings:
- The patient's arrhythmia resolved after holding the opioid agonist medications.
- She was discharged on mexiletine with a normalized QTc interval.
- No further cardiac events were reported.
Implications:
- This case underscores the potential for fatal cardiac complications from overdosing on prescribed opioid agonist medications for IBS.
- Physicians must consider OTC medication use and judiciously assess for drug-induced arrhythmia in patients presenting with syncope.
- Increased awareness is needed regarding the cardiac risks associated with high-dose loperamide and related compounds in IBS management.
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