Loperamide toxicity

Background

Loperamide is widely used nonprescription anti-diarrheal medication
Increasing reports of intentional overdose at very high doses either for euphoric effects or to attenuate symptoms of opioid withdrawal[1]
Has a wide margin of safety, largely due to extremely low bioavailability (0.3%)[1]

Clinical Features

May have features of conventional opioid toxicity

Loperamide-induced cardiac toxicity[1]

Often young
May present in cardiac arrest or with recurrent syncope in conjunction with ECG agnormalities

Differential Diagnosis

Sedative/hypnotic toxicity

Evaluation

ECG Findings

QT prolongation
QRS widening
Ventricular dysrhythmias

Management

Supportive care / standard ACLS
Consider:

Disposition

See Also

Loperamide

External Links

References

Wu PE, et al. "Clinical Review: Loperamide Toxicity." Annals of EM. August 2017. 70(2):245-252

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