Brugada Syndrome Associated With Adolescent Loperamide Abuse

Stefek, Bryan; Wolfe, L. Timothy; Cohen, Mark H.

doi:10.1542/peds.2018-1423

Cited by 10 publications

(6 citation statements)

References 15 publications

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“…respiratory depression, altered mental status, miosis), and cardiovascular effects (e.g. ventricular dysrhythmias and electrocardiogram alterations, such as prolonged QT, QRS widening and torsades-de-pointes), which might be fatal[41,[93][94][95][96][97][98][99][100][101].Consistently, loperamide exposures reported to the NPDS indicated intentional misuse and abuse, there was a 91% increase in reported exposures from 2010 to 2015 with a total of 201 and 383 exposures in 2010 and 2015, with a rate of approximately 38 cases per year) [102], most of them involving single-agent loperamide abuse and cardiotoxicity ([102-103]. Since September 2019 the Food and Drug Administration (FDA) have limited loperamide package sizes in an effort to reduce inappropriate use [104].…”

mentioning

confidence: 99%

Misuse of prescription and over-the-counter drugs to obtain illicit highs: how pharmacists can prevent abuse

Chiappini¹,

Guirguis²,

Corkery³

et al. 2020

The Pharmaceutical Journal

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There have been increasing reports of misuse of a range of prescription and over-the-counter (OTC) drugs for recreational purposes. The use of psychoactive pharmaceuticals and 'pharming' are new, widespread phenomena involving the non-medical use of prescription and OTC drugs, which are recreationally used to achieve psychoactive effects either on their own or in combination with other substances. This article provides an overview of the topic, focusing on a range of medicines (e.g. prescription medicines such as quetiapine, gabapentinoids, Z-drugs, bupropion, venlafaxine, and over-thecounter medicines such as loperamide, dextromethorphan, benzydamine, promethazine, chlorphenamine, diphenhydramine and hyoscine butylbromide) that have emerged as misused and diverted, or already described through the literature, as well as recorded by drug users' online websites reporting new trends and experimentations of drug abuse. This rapidly changing drug scenario represents a challenge for pharmacy, psychiatry, public health and drug control policies. Moreover, possibly resulting from the COVID-19 pandemic, drug use-habits and availability have changed, causing a shift in behaviours relating to both prescription and OTC medicines. Healthcare professionals should be aware of potential prescription drugs diversion, recognise misuse cases, consider the possibility of polydrug misuse, and prevent it where possible. Pharmacists can play a key role in preventing and reducing drug abuse and should be involved in evidence-based actions to detect, understand and prevent drug diversion activities and the adverse effects of drug-misuse.

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mentioning

confidence: 99%

Misuse of prescription and over-the-counter drugs to obtain illicit highs: how pharmacists can prevent abuse

Chiappini¹,

Guirguis²,

Corkery³

et al. 2020

The Pharmaceutical Journal

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“…Additionally, the delay in peak levels at higher doses was thought to protect against the fast-onset characteristic of medications prone to 32,33 in addition to the formation of early after depolarizations. 32 Na channel blocking properties may also unmask type I Brugada pattern 17,30,31 as was seen in three cases from the literature review.…”

Section: Discussionmentioning

confidence: 75%

“…Enakpene described the case of a 25‐year‐old female who received a dual‐chamber ICD which required maximal pacing output to capture myocardium. Loperamide due to Na channel blocking properties may also unmask type I Brugada pattern as was seen in three cases from the literature review.…”

Section: Discussionmentioning

confidence: 78%

Electrocardiographic changes in loperamide toxicity: Case report and review of literature

Teigeler

Stahura

Alimohammad

et al. 2019

Cardiovasc electrophysiol

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Introduction Loperamide, an antidiarrheal agent, is a µ‐opioid receptor agonist increasingly abused to prevent opioid withdrawal or to produce euphoric effects. At supra‐therapeutic doses, loperamide can cause cardiac toxicity due to blockade of Na and IKr channels, resulting in wide QRS rhythms, severe bradycardia, prolonged QTc, polymorphic ventricular tachycardia, cardiac arrest, and death. There are limited data on the cardiotoxic effects of high dose loperamide. Methods and Results A case report of loperamide toxicity is presented and then added to a contemporary review of the literature. In total, the presentation and management of 36 cases of loperamide cardiotoxicity are summarized. The overall median daily dose (interquartile range) of loperamide was 200 (134‐400) mg. The median QRS duration was 160 (125‐170) ms. The median QTc duration was 620 (565‐701) ms. Ventricular tachycardia was experienced by 24/36 (67%) of patients, 20 of which were specified to be polymorphic. Treatment was supportive, providing advanced cardiopulmonary life support and aggressive electrolyte repletion. Isoproterenol infusion or overdrive pacing was employed in 19/36 (53%) of cases. The median time to electrocardiogram normalization or hospital discharge, whichever came first, was 5 (3.5‐10) days. Conclusion Loperamide overdose is a toxidrome that remains underrecognized, and in patients with unexplained cardiac arrhythmias, loperamide toxicity should be suspected. Prompt recognition is critical due to the delayed recovery and high risk for life‐threatening arrhythmias.

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“…Extreme doses of loperamide have been reported to provoke dangerous arrhythmias and sudden death. [1][2][3] These arrhythmias include prolonged QTc, ventricular fibrillation and torsades des pointes. The daily doses used by the patients in those case reports ranges from 192 mg to 400 mg. Interestingly, genetically confirmed Brugada syndrome became apparent on the ECG of an adolescent with chronic loperamide overuse, with subsequent resolution of the Brugada pattern once loperamide was ceased.…”

Section: Discussionmentioning

confidence: 99%

“…The daily doses used by the patients in those case reports ranges from 192 mg to 400 mg. Interestingly, genetically confirmed Brugada syndrome became apparent on the ECG of an adolescent with chronic loperamide overuse, with subsequent resolution of the Brugada pattern once loperamide was ceased. 2 This implies that loperamide has the ability to unmask congenital cardiac arrhythmias.…”

Section: Discussionmentioning

confidence: 99%