Loperamide toxicity

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  • 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

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


ECG Findings



See Also

External Links


  1. 1.0 1.1 1.2 Wu PE, et al. "Clinical Review: Loperamide Toxicity." Annals of EM. August 2017. 70(2):245-252