Department of Emergency Medicine, Upstate Medical University , Syracuse NY , USA.
Clin Toxicol (Phila). 2014 Nov;52(9):952-7. doi: 10.3109/15563650.2014.969371.
Prescription opioid abuse is a major public health concern and an ongoing epidemic in the United States. Loperamide is a widely available and inexpensive over-the-counter antidiarrheal with peripheral mu-opioid receptor activity. Online resources discuss the use of loperamide for the amelioration of withdrawal symptoms or recreational abuse. We describe the clinical course of 5 patients abusing loperamide, 3 of whom had life-threatening cardiac arrhythmias.
In this observational case series, patients with cardiac arrhythmias or history of loperamide abuse with cardiac arrhythmias were identified; 5 patients were identified and 4 of the 5 patients were seen directly at the bedside. Clinical profile and outcome of patients is reported.
We report 5 patients with history of loperamide abuse; 3 of the 5 patients had life-threatening cardiac arrhythmias. One of the patients experienced a second life-threatening arrhythmia after he resumed loperamide abuse. Loperamide levels were obtained in 4 of the 5 patients and were at least one order of magnitude greater than therapeutic concentrations. Discontinuation of loperamide resulted in complete resolution of cardiac conduction disturbances.
This case series describes several patients with cardiac conduction abnormalities and life-threatening ventricular arrhythmias temporally related to loperamide abuse. With the recent efforts to restrict the diversion of prescription opioids, increasing abuse of loperamide as an opioid substitute may be seen. Toxicologists should be aware of these risks and we urge all clinicians to report such cases to FDA Medwatch(®).
处方类阿片类药物滥用是美国一个主要的公共卫生关注点和持续存在的流行问题。洛哌丁胺是一种广泛应用且价格低廉的非处方抗腹泻药，具有外周μ-阿片受体活性。在线资源讨论了使用洛哌丁胺来缓解戒断症状或娱乐性滥用的问题。我们描述了 5 名滥用洛哌丁胺的患者的临床过程，其中 3 名患者出现了危及生命的心律失常。
在这项观察性病例系列研究中，确定了有心律失常的阿片类药物滥用患者或有阿片类药物滥用相关心律失常病史的患者；共确定了 5 名患者，其中 4 名在床边直接观察到。报告了患者的临床特征和结局。
我们报告了 5 名有洛哌丁胺滥用史的患者；其中 3 名患者出现危及生命的心律失常。其中一名患者在恢复滥用洛哌丁胺后再次出现危及生命的心律失常。在 5 名患者中的 4 名获得了洛哌丁胺水平，其水平至少比治疗浓度高一个数量级。停止使用洛哌丁胺后，心脏传导障碍完全缓解。
本病例系列描述了数名患者出现心脏传导异常和与洛哌丁胺滥用时间相关的危及生命的室性心律失常。随着限制处方类阿片类药物滥用的努力不断增加，越来越多的人可能会滥用洛哌丁胺作为阿片类药物的替代品。毒理学家应该意识到这些风险，我们敦促所有临床医生向 FDA Medwatch(®)报告此类病例。
