title: Loperamide metabolite-induced cardiomyopathy and QTc prolongation.
abstract: Loperamide 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.
authors.affiliation: a Department of Medicine , State University of New York , Syracuse , NY , USA.
authors.forename: Zabeer
authors.identifier: http://orcid.org/0000-0002-7161-4750
authors.initials: Z
authors.lastname: Bhatti
authors.affiliation: a Department of Medicine , State University of New York , Syracuse , NY , USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Norsworthy
authors.affiliation: a Department of Medicine , State University of New York , Syracuse , NY , USA.
authors.forename: Tamas
authors.initials: T
authors.lastname: Szombathy
mesh_terms: D000328:Adult; D000930:Antidiarrheals / Q000493:pharmacokinetics / Q000506:poisoning*; D001711:Biotransformation; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D062787:Drug Overdose / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008133:Long QT Syndrome / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D008139:Loperamide / Q000031:analogs & derivatives / Q000493:pharmacokinetics / Q000506:poisoning*; D011237:Predictive Value of Tests; D013406:Suicide, Attempted
chemical_list: D000930:Antidiarrheals; C419149:N-demethylloperamide; D008139:Loperamide
keywords: Loperamide toxicity; complications of poisoning; desmethylloperamide