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Requests for reprints should be addressed to Evbu O. Enakpene, MD, Sarver Heart Center, Banner-University Medical Center, University of Arizona Medical Center, 1501 N Campbell Avenue, Tucson, AZ 85724.
Center for Pharmacology, Toxicology Education & Research, University of Arizona College of Medicine-Phoenix, PhoenixArizona Poison & Drug Information Center, University of Arizona College of Pharmacy, Tucson
The source of a 25-year-old woman's puzzling signs and symptoms could not be determined
until a search of her home yielded the answer. She had no known medical problems when
she presented to the Emergency Department with a 2-week history of persistent abdominal
discomfort. A routine work-up for abdominal pain was unrevealing. An electrocardiogram
(ECG) showed sinus rhythm at a rate of 69 beats per minute with a QT interval of 492
ms, a corrected QT interval of 527 ms, an intraventricular conduction defect with
a QRS interval of 170 ms, and nonspecific T-wave abnormalities (Figure 1). She was treated symptomatically for abdominal pain and discharged with no medications.
Figure 1An electrocardiogram was obtained during the patient's initial evaluation for abdominal
pain of 2 weeks duration. It was notable for a prolonged QT interval of 492 ms, corrected
QT interval of 527 ms, and a QRS interval of 170 ms.
Loperamide blocks high-voltage-activated calcium channels and N-methyl-D-aspartate-evoked responses in rat and mouse cultured hippocampal pyramidal neurons.
Enakpene et al1 inform electrocardiogram alterations related to loperamide abuse. Because the drug is available over the counter, unregulated use is frequent to control gastrointestinal symptoms, mainly diarrhea and unfortunately as an increasing nonillicit drug of abuse in opioid users.1
