Loperamide-Induced Torsades de Pointes.

Area of Science:

• Cardiology
• Pharmacology
• Toxicology

Background:

• Loperamide, an over-the-counter medication for diarrhea, acts on intestinal opioid receptors at therapeutic doses.
• At supratherapeutic doses, loperamide affects central opioid receptors, leading to potential abuse among individuals with opioid use disorder.
• Increased regulation of opioid prescriptions has led to a rise in loperamide abuse.

Observation:

• The case involves a 27-year-old female with a history of heroin abuse.
• The patient experienced a loperamide overdose.

Findings:

• Supratherapeutic loperamide doses can cause severe cardiac toxicity.
• Cardiac manifestations include wide QRS rhythms, severe bradycardia, prolonged QTc interval, and polymorphic ventricular tachycardia.
• The patient presented with torsades de pointes, a specific type of polymorphic ventricular tachycardia, leading to cardiac arrest.

Implications:

• Loperamide abuse poses a significant risk for severe cardiac events, including fatal arrhythmias.
• Healthcare providers should be aware of the cardiac risks associated with loperamide misuse.
• This case underscores the need for vigilance regarding the misuse of readily available medications for recreational or self-treatment purposes.