Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 30;7(5):ytad152.
doi: 10.1093/ehjcr/ytad152. eCollection 2023 May.

Loperamide-induced cardiac toxicity and lipid emulsion treatment

Ju-Tae Sohn  1   2
Affiliations

Loperamide-induced cardiac toxicity and lipid emulsion treatment

Ju-Tae Sohn. Eur Heart J Case Rep. .
No abstract available

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
The putative underlying mechanisms of lipid emulsion (LE) treatment for loperamide-induced cardiac toxicity, which may be partially similar to those of LE treatment for bupivacaine-induced cardiac toxicity., Loperamide (log p: 5.13) and bupivacaine (log p: 3.41) are highly lipid-soluble (log p: >2). In addition, toxic doses of loperamide and bupivacaine similarly induce QRS widening, QTc prolongation, Torsade de Pointes, and cardiac arrest by inhibiting the cardiac sodium and human ether-à-go-go-related gene (hERG) potassium channels. Moreover, LE alone provides a positive inotropic effect. LE may absorb highly lipid-soluble loperamide from the heart, leading to recovery from toxic does of loperamide-induced Torsade de Pointes and myocardial depression through less inhibition of cardiac sodium and hERG potassium channels, and positive inotropic effect.
See this image and copyright information in PMC

Comment in

  • doi: 10.1093/ehjcr/ytad241
  • doi: 10.1093/ehjcr/ytad205

References

    1. Hegde V, Dalia T, Tayeb T, Cotter E, Vidic A. Loperamide-induced cardiogenic syncope: a case report of a life-threatening presentation of an over-the-counter drug. Eur Heart J Case Rep 2023;7:ytad059. - PMC - PubMed
    1. Wu PE, Juurlink DN. Clinical review: loperamide toxicity. Ann Emerg Med 2017;70:245–252. - PubMed
    1. Lee SH, Sohn JT. Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative review. Korean J Anesthesiol 2023. doi:10.4097/kja.23031. Epub ahead of print. PMID: 36704816. - DOI - PMC - PubMed
    1. Lee SH, Kim S, Sohn JT. Lipid emulsion treatment for drug toxicity caused by nonlocal anesthetic drugs in pediatric patients: a narrative review. Pediatr Emerg Care 2023;39:53–59. - PubMed
    1. Long WM, Sinnott VB, Bracker K, Thomas D. Use of 20% intravenous lipid emulsion for the treatment of loperamide toxicosis in a Collie homozygous for the ABCB1-1Δ mutation. J Vet Emerg Crit Care (San Antonio) 2017;27:357–361. - PubMed

LinkOut - more resources