Daoub Mohamed, Cawley Philippa, Sahu Jonathan
Internal Medical Trainee Northern General Hospital, Sheffield, S5 7AU.
Consultant Cardiologist/Electrophysiologist Northern General Hospital, Sheffield, S5 7AU.
Br J Cardiol. 2021 Oct 13;28(4):46. doi: 10.5837/bjc.2021.046. eCollection 2021.
Loperamide is an over-the-counter, peripherally-acting, -opioid receptor agonist commonly used in the treatment of diarrhoea. It has increasingly been recognised as a potential drug of misuse, having previously been thought to have low potential for abuse owing to its low bioavailability and poor penetration of the central nervous system. High doses can result in life-threatening cardiac-toxicity. We present a case of a young woman who had been self-treating her depression with high doses of loperamide for one year, who then presented to hospital with syncope secondary to ventricular tachycardia (VT). While in the emergency department (ED) the patient had monomorphic pulseless VT requiring electrical cardioversion multiple times. Transfer to a tertiary cardiac centre was immediately arranged after she was stabilised and intubated. This complicated the diagnostic process as a thorough history could not be obtained on arrival to the tertiary centre, which meant the loperamide misuse only came to light multiple days into admission, after the patient was extubated. The final diagnosis of loperamide-induced secondary long-QT syndrome was made and the patient made a full recovery.
洛哌丁胺是一种非处方的外周作用性μ-阿片受体激动剂，常用于治疗腹泻。它越来越被认为是一种有滥用潜力的药物，此前由于其生物利用度低和对中枢神经系统的穿透性差，被认为滥用潜力较低。高剂量可导致危及生命的心脏毒性。我们报告一例年轻女性病例，她用高剂量洛哌丁胺自我治疗抑郁症一年，随后因室性心动过速（VT）继发晕厥入院。在急诊科时，患者出现单形性无脉性室性心动过速，需要多次进行电复律。在她病情稳定并插管后，立即安排转至三级心脏中心。这使诊断过程变得复杂，因为到达三级中心时无法获得详尽的病史，这意味着直到患者拔管后入院数天，洛哌丁胺滥用情况才被发现。最终诊断为洛哌丁胺诱发的继发性长QT综合征，患者完全康复。
