University of Central Florida College of Medicine HCA GME Consortium; North Florida Regional Medical Center, Internal Medicine, Gainesville, Florida.
University of Florida, College of Medicine, Gainesville, Florida.
Am J Emerg Med. 2018 Sep;36(9):1716.e1-1716.e3. doi: 10.1016/j.ajem.2018.05.027. Epub 2018 May 18.
Loperamide is an over-the-counter anti-diarrheal medication that is inexpensive, easily accessible, and widely used. It is generally thought to be safe and effective without the potential for abuse. However, recent discovery of its ability to treat opioid withdrawal symptoms at high doses has led to not only its abuse, but also the need to recognize its cardiotoxicity due to the ability to prolong the QTc interval. We report a case of a 33 year old female with a history of opioid dependence who presented to the emergency department with acute onset shortness of breath and generalized weakness who was subsequently found to be in ventricular tachycardia. Electrocardiogram showed prolongation of the QTc and the patient later admitted to ingestion of 70 loperamide pills daily for the past year in order to alleviate her opioid withdrawal symptoms. Due to increased loperamide abuse and toxicity displayed within the last several years, public and health provider awareness should be optimized to fully understand its lethality, and stricter regulations on its availability to the general population should be considered. Even in asymptomatic patients with ECG abnormalities, emergency medicine physicians should admit them for further monitoring and aggressive medical therapy.
洛哌丁胺是一种非处方抗腹泻药物，价格便宜、易于获得且广泛使用。一般认为它是安全有效的，没有滥用的可能。然而，最近发现高剂量的洛哌丁胺可以治疗阿片类药物戒断症状，这不仅导致了其滥用，还需要认识到它的心脏毒性，因为它能够延长 QT 间期。我们报告了一例 33 岁女性，有阿片类药物依赖史，因急性发作性呼吸困难和全身无力就诊于急诊科，随后被发现患有室性心动过速。心电图显示 QT 间期延长，患者后来承认过去一年每天服用 70 片洛哌丁胺，以缓解阿片类药物戒断症状。由于近年来洛哌丁胺滥用和毒性增加，应优化公众和卫生提供者的意识，以充分了解其致命性，并应考虑对其在普通人群中的可用性进行更严格的监管。即使是心电图异常但无症状的患者，急诊医生也应将其收治入院，进行进一步监测和积极的药物治疗。
