• Christie Sun, Jessica A Brice, and Richard F Clark.
• Division of Medical Toxicology, University of California San Diego, San Diego, California; Department of Emergency Medicine, University of California San Diego, San Diego, California.
• J Emerg Med. 2018 Apr 1; 54 (4): 484-486.

BackgroundLoperamide has been increasing in popularity recently for its effects separate from treatment of diarrhea. In large doses or in combination with other agents, it can lead to desirable effects in the central nervous system. However, cardiotoxicity has been reported with its abuse.Case ReportA 49-year-old male who had been chronically abusing loperamide was found to have Brugada-like changes on his electrocardiogram (ECG). He had no other clinical symptoms associated with Brugada syndrome and did not have similar findings on previous ECGs. After abstaining from further loperamide use during hospitalization, this pattern slowly resolved without clinically significant dysrthymias. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: A patient with a history of loperamide abuse is at risk for cardiotoxicity. While other dysrhythmias are reported more commonly with loperamide abuse, Brugada-like ECG changes can occur and warrant appropriate consultation and prompt follow-up.Copyright © 2017 Elsevier Inc. All rights reserved.

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