How I Survived Loperamide Cardiotoxicity
I have no business being alive. Ask anyone who saved my life — I shouldn’t be here. When I first got sick, I thought I had a stomach virus. It was the middle of winter and it seemed like all my co-workers were out sick. Unlike them, though, I had been secretly taking high doses of loperamide to relieve the symptoms of opiate withdrawal for several months. I was too busy and didn’t want to go through withdrawal, but the consequences of that decision were about to catch up to me.
Case Study: Loperamide Cardiotoxicity and Opioid Withdrawal
A 43-year-old female presented to the emergency department (ED) with syncope. While in the ED, she experienced multiple episodes of torsades de pointe and ventricular arrhythmias. Intravenous lidocaine, amiodarone, sodium bicarbonate, magnesium, and fatty acid emulsion therapy were all given. She required repeated cardioversion, with at least 15 shocks. Control was ultimately achieved by transvenous pacemaker insertion with overdrive pacing. She required overdrive pacing for three days. She reported taking 144 tablets of loperamide (each 2 mg) daily, totaling 288 mg, to manage symptoms of opioid withdrawal.