Loperamide toxicity: Difference between revisions
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==Background== | ==Background== | ||
*[[Loperamide]] is widely used nonprescription anti-diarrheal medication | *[[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]]<ref>Wu PE, et al. "Clinical Review: Loperamide Toxicity." Annals of EM. August 2017. 70(2):245-252</ref> | *Increasing reports of intentional overdose at very high doses either for euphoric effects or to attenuate symptoms of [[opioid withdrawal]]<ref name="Wu">Wu PE, et al. "Clinical Review: Loperamide Toxicity." Annals of EM. August 2017. 70(2):245-252</ref> | ||
*Has a wide margin of safety, largely due to extremely low bioavailability (0.3%)<ref | *Has a wide margin of safety, largely due to extremely low bioavailability (0.3%)<ref name="Wu" /> | ||
==Clinical Features== | ==Clinical Features== | ||
*May have features of conventional [[opioid toxicity]] | *May have features of conventional [[opioid toxicity]] | ||
===[[Loperamide]]-induced cardiac toxicity<ref | ===[[Loperamide]]-induced cardiac toxicity<ref name="Wu" />=== | ||
*Often young | *Often young | ||
*May present in cardiac arrest or with recurrent [[syncope]] in conjunction with [[ECG]] agnormalities | *May present in cardiac arrest or with recurrent [[syncope]] in conjunction with [[ECG]] agnormalities | ||
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==Disposition== | ==Disposition== | ||
==See Also== | ==See Also== | ||
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==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Toxicology]] | |||
Latest revision as of 08:38, 14 August 2017
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
- Absinthe
- Barbiturates
- Benzodiazepines
- Chloral hydrate
- Gamma hydroxybutyrate (GHB)
- Baclofen toxicity
- Opioids
- Toxic alcohols
- Xylazine toxicity
Evaluation
ECG Findings
- QT prolongation
- QRS widening
- Ventricular dysrhythmias
Management
- Supportive care / standard ACLS
- Consider: