A Heart-Wrenching Case of Loperamide Toxicity

Sadaf Sheikh, M. Baig
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引用次数: 1

Abstract

Background: Loperamide is an insoluble meperidine analog that is commonly used for diarrhea. It is an inexpensive and frequently available over the counter drug. While physicians are aware of its opioid effects, Loperamide use is also linked to cardiac conduction disturbances. Case presentation: We present a case of Loperamide toxicity with QRS, Corrected QT interval (QTc) prolongation and ventricular arrhythmias such as ventricular tachycardia leading to cardiopulmonary resuscitation (CPR). The patient survived and was evaluated to have prolonged QT interval. He later disclosed over the counter (OTC) and continued a regular use of Loperamide as an anti-diarrheal agent. During the rest of hospital stay, serial Electrocardiograms (ECGs) showed improvement in QT interval and patient was successfully discharged.  Conclusion: Loperamide inhibits intestinal peristalsis through its peripheral µ-opioid receptor agonism, as well as calcium channel blockade. Loperamide abuse is increasing, as patients use it either to experience euphoric effects or to attenuate the effects of opioid withdrawal.At high doses, Loperamide blocks cardiac sodium and potassium channels, resulting in prolonged QRS and QT intervals which can proceed to cardiac rhythm disturbances. Our case shows the acute and delayed cardiac effects of Loperamide toxicity which the treating physician should be made well aware of.
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洛哌丁胺中毒1例
背景:洛哌丁胺是一种不溶性哌替啶类似物,常用于腹泻。它是一种廉价的非处方药,经常可以买到。虽然医生意识到它的阿片类药物作用,但洛哌丁胺的使用也与心脏传导障碍有关。病例介绍:我们报告一例洛哌丁胺毒性伴QRS,校正QT间期(QTc)延长和室性心律失常,如室性心动过速导致心肺复苏(CPR)。患者存活,经评估QT间期延长。他后来在柜台(OTC)披露,并继续定期使用洛哌丁胺作为抗腹泻剂。在剩余的住院期间,连续心电图显示QT间期改善,患者顺利出院。结论:洛哌丁胺通过其外周微阿片受体激动作用和钙通道阻断作用抑制肠道蠕动。洛哌丁胺的滥用正在增加,因为患者使用它来体验欣快效果或减轻阿片类药物戒断的影响。高剂量时,洛哌丁胺阻断心脏钠和钾通道,导致QRS和QT间期延长,从而导致心律紊乱。我们的病例显示了洛哌丁胺毒性的急性和延迟的心脏影响,治疗医生应该充分认识到这一点。
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审稿时长
12 weeks
期刊介绍: Asia Pacific Journal of Medical Toxicology (APJMT) aims to expand the knowledge of medical toxicology and tries to provide reliable information in this field for medical and healthcare professionals. APJMT mainly focuses on research related to medical toxicology issues in the Asia Pacific region and publishes articles on clinical and epidemiological aspects of toxicology, poisonings emergency care, addiction, drug interactions and adverse effects. The journal accepts and welcomes high quality papers in the form of original articles and rarely review articles, case reports and scientific letters relevant to medical practice in toxicology.
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