Loperamide toxicity: Difference between revisions
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*[[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>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>Wu PE, et al. "Clinical Review: Loperamide Toxicity." Annals of EM. August 2017. 70(2):245-252</ref> | |||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 07:32, 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%)[2]
Clinical Features
- May have features of conventional opioid toxicity
Loperamide-induced cardiac toxicity[3]
- 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: