• Clin Toxicol (Phila) · Aug 2017

    Case Reports

    Loperamide metabolite-induced cardiomyopathy and QTc prolongation.

    • Zabeer Bhatti, Jessica Norsworthy, and Tamas Szombathy.
    • a Department of Medicine , State University of New York , Syracuse , NY , USA.
    • Clin Toxicol (Phila). 2017 Aug 1; 55 (7): 659-661.

    AbstractLoperamide is an over-the-counter, peripherally acting, μ-opioid receptor agonist used for the treatment of diarrhea. In recent times users have found that at higher doses, loperamide crosses the blood-brain barrier and reaches central μ-receptors in the brain, leading to central opiate effects including euphoria and respiratory depression. We report a case of a 37-year-old female who attempted suicide with over 200 loperamide tablets. During her overdose, her QTc was significantly prolonged at >600 ms. Our case aims to add to the growing body of literature describing life-threatening ventricular arrhythmias associated with loperamide toxicity and further suggests that a metabolite of loperamide, desmethylloperamide, may play a role in the pathogenesis.

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