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Torsade de pointes following repeated massive loperamide (Imodium) ingestions.

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Argirios Argiriou:
Läkartidningen, 29-01-2020

The anti-diarrheal drug loperamide is a mu-opioid agonist with poor systemic bioavailability at standard doses. However, at very high doses bioavailability increases, due to saturation of P-glycoprotein and first-pass metabolism, leading both to opioid effects on the central nervous system and possible systemic side effects. There have been several reports in the literature recently regarding life-threatening cardiovascular symptoms after longstanding daily intake of massive loperamide doses. We hereby describe a patient with syncope who displayed wide QRS complexes and prolonged QTc intervals on ECG upon arrival to hospital. The patient developed typical bursts of torsade de pointes during a prolonged hospital course.

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