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Abstract
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BACKGROUND: Loperamide is an over-the-counter anti-diarrheal mu-opioid analogue that has appeared more frequently in emergency department patients in excessive doses to mitigate opioid cravings and withdrawal symptoms. Given the concern for its abuse potential and serious cardiotoxicity at high doses, we aimed to describe the cardiac effects in patients with loperamide ingestions reported to the Texas Poison Center Network (TPCN).
METHODS: Single agent loperamide ingestions for all ages were extracted from the TPCN database from 2004 to 2021. We defined exposure reasons and medical outcomes according to the America's Poison Centers' classification system.
RESULTS: The TPCN recorded 1,421 single agent loperamide ingestions during this period, with a mean of 79 ingestions annually. Most cases (n=931, 65.5%) occurred in children under six years of age and were evenly split between males and females. Most cases were unintentional (n=904, 64.0%), while 12.7% (n=181) were for abuse, misuse, and suspected suicide. Most cases (72.6%) experienced no or minimal effects. Cardiac events occurred in 33 patients (2.3%) and included tachycardia (n=19, 57.6%), bradycardia (n=10, 30.3%), ventricular tachycardia (n=8, 24.2%), conduction disturbance (n=7, 21.2%), asystole (n=2, 6.1%), and cardiac arrest (n=4, 12.1%). Three of the four cardiac arrest cases were for "suspected suicide," "intentional abuse," and "unknown intent," while the fourth was "unknown relation to the exposure." Most (n=25, 75.8%) cases with a cardiac event were intentional exposures.
CONCLUSIONS: Most single agent loperamide ingestions reported to the TPCN were unintentional and occurred in patients under six years of age. A portion of patients experienced multiple cardiac events (conduction disturbances, dysrhythmias, and cardiac arrests) related to loperamide ingestions
Language: en |