Loperamide Induced Recurrent Torsades de Pointes: A Case Report.

Area of Science:

• Cardiology
• Toxicology
• Pharmacology

Background:

• The current opioid epidemic has led to increased misuse of over-the-counter medications.
• Loperamide, an opioid receptor agonist, is increasingly abused for its euphoric effects and to manage opioid withdrawal.
• High doses of loperamide can lead to cardiotoxicity, including QT interval prolongation and Torsades de Pointes (TdP).

Observation:

• A 40-year-old male with a history of opioid abuse presented with altered mental status and hyperthermia after daily loperamide use for 5 years.
• The patient exhibited a prolonged QTc interval and experienced two episodes of Torsades de Pointes (TdP), leading to cardiac arrest.
• Initial management included isoproterenol and overdrive pacing, with subsequent administration of methylnaltrexone.

Findings:

• Loperamide overdose was confirmed as the cause of recurrent Torsades de Pointes (TdP) and cardiac arrest.
• The patient's cardiac arrhythmias resolved with aggressive medical management, including isoproterenol, overdrive pacing, and methylnaltrexone.
• No further episodes of TdP or cardiac arrest occurred after treatment.

Implications:

• This case underscores the critical need for medical providers to be aware of loperamide's cardiotoxic potential.
• Increased vigilance and screening for loperamide abuse are essential in patients presenting with cardiac arrhythmias, especially during the opioid crisis.
• Prompt recognition and management of loperamide-induced TdP are crucial for patient survival.