Poor Man's Methadone: A Case Report of Loperamide Toxicity

@article{Dierksen2015PoorMM,
  title={Poor Man's Methadone: A Case Report of Loperamide Toxicity},
  author={Jennifer E. Dierksen and Morna L Gonsoulin and Jeffrey P. Walterscheid},
  journal={The American Journal of Forensic Medicine and Pathology},
  year={2015},
  volume={36},
  pages={268–270}
}
Loperamide, a common over-the-counter antidiarrheal drug and opioid derivative, is formulated to act upon intestinal opioid receptors. [...] Key Method At autopsy, the only significant findings were a distended bladder and bloody oral purge. Drug screening found nontoxic levels of alprazolam, fluoxetine, and marijuana metabolites. Liquid chromatography time-of-flight mass spectrometry found an unusual set of split isotope peaks consistent with chlorine.Expand
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TLDR
The existing knowledge on loperamide, including its chemistry, synthesis, pharmacology, toxicology, pharmacokinetics, biotransformation, its medicinal use, dependence potential, abuse of the drug, reported intoxications, fatalities, its determinations in biological samples, and its current legal status are reviewed.
Loperamide-Induced Torsades de Pointes
Loperamide, an over-the-counter antidiarrheal, works on the µ opioid receptor with minimal opioid activity if taken as directed. Recently, it has gained popularity as the “poor man's methadone” at
Loperamide-Induced Torsades de Pointes: A Case Series.
TLDR
Emergency physicians should proceed with caution when treating patients with loperamide toxicity, and promptly treat ECG abnormalities aggressively, and admit all patients for further monitoring.
Loperamide as a Potential Drug of Abuse and Misuse: Fatal Overdoses at the Medical University of South Carolina
TLDR
Loperamide overdoses are a growing concern from both a forensic and clinical standpoint, and the frequency of reported cases will likely increase as awareness grows within the medical and toxicological communities.
Loperamide, the “Poor Man’s Methadone”: Brief Review
TLDR
Providers need to be alert to users' not forthcoming and routine drug screens do not detect loperamide in order to recognize intoxication, be able to screen for use, and facilitate entry into treatment.
A Case Report of Torsade de Pointes and Brugada Pattern Associated with Loperamide Misuse and Supratherapeutic Loperamide Concentrations.
TLDR
A 22-year-old man who presented in cardiac arrest from polymorphic ventricular tachycardia consistent with TdP and a Type 1 Brugada pattern after intentional loperamide abuse is presented.
Epidemiologic Trends in Loperamide Abuse and Misuse
TLDR
Loperamide abuse and misuse are projected to increase in the absence of any methods to reduce exposure or curb abuse, and health care providers should consider the potential for loperamide toxicity when managing patients with opioidlike toxicity.
Clinical Review: Loperamide Toxicity
TLDR
In patients who survive loperamide toxicity, consideration should be given to the treatment of an underlying opioid use disorder, if present, and the mainstays of treatment include advanced cardiac life support and supportive care, although selected patients may be candidates for overdrive pacing, intravenous lipid emulsion, or extracorporeal membrane oxygenation.
Loperamide metabolite-induced cardiomyopathy and QTc prolongation
TLDR
This case aims to add to the growing body of literature describing life-threatening ventricular arrhythmias associated with loperamide toxicity and suggests that a metabolite of loperamia, desmethylloperamide, may play a role in the pathogenesis.
Loperamide misuse and abuse.
TLDR
The potential for loperamide misuse and abuse is increasing in the United States, and pharmacists are encouraged to monitor and restrict their sales.
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The medical examiner ruled that the cause of death was loperamide and ethanol intoxication, and the manner of death as undetermined, which is similar to that of an over-the-counter antidiarrheal case.
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It is believed that loperamide, like other morphine derivates, can be responsible for the elevation of pancreatic enzymes due to a spasm of Oddi's sphincter, and was the most likely explanation for this patient's condition.
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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 lopersamide as an opioid substitute may be seen.
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Loperamide is probably superior to diphenoxylate in providing symptomatic control of chronic diarrhoea such as that associated with chronic inflammatory bowel disease or following gastrointestinal surgery, It has been used for up to 3 years in such conditions without evidence of tolerance and the possibility of once daily dosage of loperamide in chronic diarrhea is an advantage.
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This study searched the literature for papers containing data on drug–drug interactions of loperamide‐containing products in humans and reviewed the internal worldwide safety database of Johnson & Johnson for spontaneous case reports suggestive of a central opioid effect after coadministration of Loperamide with a P‐glycoprotein inhibitor or substrate.
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Findings suggest that intraregional variation should be examined more closely, as the findings may have implications for the organisation of treatment for end stage renal failure in the National Health Service.
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