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Clinical Toxicology Volume 53, 2015 - Issue 5
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Letter to the Editor

Loperamide toxicokinetics: serum concentrations in the overdose setting

William EgglestonSUNY Upstate Medical University, Department of Emergency Medicine, Upstate New York Poison Center, Syracuse, NY, USACorrespondence[email protected]
,
Nicholas NaccaSUNY Upstate Medical University, Department of Emergency Medicine, Upstate New York Poison Center, Syracuse, NY, USA
&
Jeanna M. MarraffaSUNY Upstate Medical University, Department of Emergency Medicine, Upstate New York Poison Center, Syracuse, NY, USA
Pages 495-496 | Received 16 Jan 2015, Accepted 03 Mar 2015, Published online: 30 Mar 2015

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Zain Ali, Umer Shoukat, Mariya Khan, Sohaib Roomi & Waqas Ullah. (2020) ‘ Loperamide overdose induces ventricular tachycardia with catastrophic outcomes’. Journal of Community Hospital Internal Medicine Perspectives 10:3, pages 229-232.
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William Eggleston, Robert Palmer, Pierre-André Dubé, Stephen Thornton, Andrew Stolbach, Diane P Calello & Jeanna M Marraffa. (2020) Loperamide toxicity: recommendations for patient monitoring and management. Clinical Toxicology 58:5, pages 355-359.
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Brandon Masi Parker, Tejaus Rao, Ann Matta, Megan Quitanna, H. Neal Reynolds, Deborah M Stein & Daniel Haase. (2019) Loperamide induced cardiac arrhythmia successfully supported with veno-arterial ECMO (VA-ECMO), molecular adsorbent recirculating system (MARS) and continuous renal replacement therapy (CRRT). Clinical Toxicology 57:11, pages 1118-1122.
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Justin P. Reinert & Rebecca L. Dunn. (2019) Management of overdoses of loperamide, gabapentin, and modafinil: a literature review. Expert Review of Clinical Pharmacology 12:9, pages 901-908.
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Vincent R. Lee, Ariel Vera, Andreia Alexander, Bruce Ruck, Lewis S. Nelson, Paul Wax, Sharan Campleman, Jeffrey Brent & Diane P. Calello. (2019) Loperamide misuse to avoid opioid withdrawal and to achieve a euphoric effect: high doses and high risk. Clinical Toxicology 57:3, pages 175-180.
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William Eggleston, Jeanna M. Marraffa & Nicholas Nacca. (2017) In response to: “Loperamide metabolite-induced cardiomyopathy and QTc prolongation”. Clinical Toxicology 55:9, pages 1023-1023.
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Articles from other publishers (36)

Hua Rong Lu, Bruce P. Damiano, Mohamed Kreir, Jutta Rohrbacher, Henk van der Linde, Tamerlan Saidov, Ard Teisman & David J. Gallacher. (2023) The Potential Mechanisms behind Loperamide-Induced Cardiac Arrhythmias Associated with Human Abuse and Extreme Overdose. Biomolecules 13:9, pages 1355.
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Peter E. Wu & David N. Juurlink. (2022) Loperamide Cardiac Toxicity: Pathophysiology, Presentation, and Management. Canadian Journal of Cardiology 38:9, pages 1378-1383.
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Tochukwu Ibe, Sean Sileno & Michael F. Harrison. (2022) 24-Year-Old Man With Syncope. Mayo Clinic Proceedings 97:3, pages 620-623.
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Raunak Mohan Nair, Bahaa Abdelghaffar & Roy Chung. (2022) Loperamide Overdose With Ventricular Tachycardia Storm. American Journal of Therapeutics 29:1, pages e129-e131.
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Vivek Modi, Matthew Krinock, Ravi Desai, Steven Stevens & Sudip Nanda. (2021) Loperamide-Induced Cardiac Events: Case Reports and Review. Cureus.
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Mark Simon & John Rague. (2021) A Case Report of Torsade de Pointes and Brugada Pattern Associated with Loperamide Misuse and Supratherapeutic Loperamide Concentrations. The Journal of Emergency Medicine 61:4, pages e54-e59.
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Jessica K. Brar, Viktoriya R. Broyan, Jeffrey T. Allgaier, Larry Nye & Andrew J. Saxon. (2020) Long-term Buprenorphine Treatment for Loperamide Use Disorder: A Case Series. Journal of Addiction Medicine 14:6, pages e378-e381.
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C. James Watson, James D. Whitledge, Alexander F. Barbuto, Katherine L. Boyle & Michael Ganetsky. (2020) Toxicity of agents used for opioid withdrawal: a case-based approach. International Anesthesiology Clinics 58:2, pages 19-27.
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N E Webb, D M Wood, J C Black, E Amioka, R C Dart & P I Dargan. (2020) Non-medical use of loperamide in the UK and the USA. QJM: An International Journal of Medicine 113:1, pages 25-30.
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Jonathan D Cicci, Sarah M Jagielski, Megan M Clarke, Robert A Rayson & Matthew A Cavender. (2019) Loperamide overdose causing torsades de pointes and requiring Impella temporary mechanical support: a case report. European Heart Journal - Case Reports 3:4, pages 1-6.
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Todd Teigeler, Heather Stahura, Rizwan Alimohammad, Gautham Kalahasty, Jayanthi N. Koneru, Michael Ellenbogen, Kenneth A. Ellenbogen & Santosh K. Padala. (2019) Electrocardiographic changes in loperamide toxicity: Case report and review of literature. Journal of Cardiovascular Electrophysiology 30:11, pages 2618-2626.
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John W. Powell & Susan Erin Presnell. (2019) Loperamide as a Potential Drug of Abuse and Misuse: Fatal Overdoses at the Medical University of South Carolina. Journal of Forensic Sciences 64:6, pages 1726-1730.
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Utkarsh Kohli, Mohammad Altujjar, Rajaninder Sharma & Sohail Hassan. (2019) Wide interindividual variability in cardiovascular toxicity of loperamide: A case report and review of literature. HeartRhythm Case Reports 5:4, pages 221-224.
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Mário L de Lemos, Jolene Guenter & Victoria Kletas. (2017) Loperamide and cardiac events: Is high-dose use still safe for chemotherapy-induced diarrhea?. Journal of Oncology Pharmacy Practice 24:8, pages 634-636.
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Michael S. Toce, Peter R. Chai, Michele M. Burns & Edward W. Boyer. (2018) Pharmacologic Treatment of Opioid Use Disorder: a Review of Pharmacotherapy, Adjuncts, and Toxicity. Journal of Medical Toxicology 14:4, pages 306-322.
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Ayodeji Okusanya & Xiaofan Li. (2018) Loperamide Abuse and Dependence: Clinical Features and Treatment Considerations. Journal of Addiction Medicine 12:6, pages 496-498.
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Asim Ahmed, Scott Freeland, Leonard Steinberg & Eric N. Prystowsky. (2018) Wide complex tachycardia and cardiomyopathy: What would you do?. Journal of Cardiovascular Electrophysiology 29:8, pages 1171-1173.
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Adrienne Hughes, Robert G. Hendrickson, Betty Chia-Chi Chen & Matthew Valento. (2018) Severe loperamide toxicity associated with the use of cimetidine to potentiate the “high”. The American Journal of Emergency Medicine 36:8, pages 1527.e3-1527.e5.
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Tamer Akel & Soad Bekheit. (2018) Loperamide cardiotoxicity: “A Brief Review”. Annals of Noninvasive Electrocardiology 23:2, pages e12505.
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Jiansong Sheng, Phu N. Tran, Zhihua Li, Sara Dutta, Kelly Chang, Thomas Colatsky & Wendy W. Wu. (2017) Characterization of loperamide-mediated block of hERG channels at physiological temperature and its proarrhythmia propensity. Journal of Pharmacological and Toxicological Methods 88, pages 109-122.
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Jessica V. Rivera, Emily Green Vance, William F. Rushton & Justin K. Arnold. (2017) Novel Psychoactive Substances and Trends of Abuse. Critical Care Nursing Quarterly 40:4, pages 374-382.
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Raphael J. Leo, Muhammad A. Ghazi & Kelly S. Jaziri. (2017) Methadone Management of Withdrawal Associated With Loperamide-related Opioid Use Disorder. Journal of Addiction Medicine 11:5, pages 402-404.
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Kenneth D. Katz, Robert D. Cannon, Matthew D. Cook, Alexandra Amaducci, Ryan Day, Joshua Enyart, Glenn Burket, Lauren Porter, Timothy Roach, Jennifer Janssen & Karl E. Williams. (2017) Loperamide-Induced Torsades de Pointes: A Case Series. The Journal of Emergency Medicine 53:3, pages 339-344.
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Peter E. Wu & David N. Juurlink. (2017) Clinical Review: Loperamide Toxicity. Annals of Emergency Medicine 70:2, pages 245-252.
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Maria Katselou, Ioannis Papoutsis, Panagiota Nikolaou, Artemisia Dona, Chara Spiliopoulou & Sotiris Athanaselis. (2017) “Poor man’s methadone” can kill the poor man. Extra-medical uses of loperamide: a review. Forensic Toxicology 35:2, pages 217-231.
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Shawna Bellew & Tyler W. Barrett. (2017) Loperamide Will Stop You Up but It Can Also Bring You Down. Annals of Emergency Medicine 69:6, pages 786-791.
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Heather Miller, Ladan Panahi, Daniel Tapia, Andrew Tran & John D. Bowman. (2017) Loperamide misuse and abuse. Journal of the American Pharmacists Association 57:2, pages S45-S50.
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Kimberley A. Swank, Eileen Wu, Cindy Kortepeter, Jana McAninch & Robert L. Levin. (2017) Adverse event detection using the FDA post-marketing drug safety surveillance system: Cardiotoxicity associated with loperamide abuse and misuse. Journal of the American Pharmacists Association 57:2, pages S63-S67.
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Daniel R. Lasoff, Cynthia H. Koh, Bryan Corbett, Alicia B. Minns & F. Lee Cantrell. (2017) Loperamide Trends in Abuse and Misuse Over 13 Years: 2002-2015. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 37:2, pages 249-253.
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William Eggleston, Kenneth H. Clark & Jeanna M. Marraffa. (2017) Loperamide Abuse Associated With Cardiac Dysrhythmia and Death. Annals of Emergency Medicine 69:1, pages 83-86.
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Noha Al-Qasmi, M. Tahir Soomro, M. Aslam, Ateeq Ur Rehman, Shahid Ali, Ekram Y. Danish, Iqbal M.I. Ismail & A. Hameed. (2016) The efficacy of the ZnO:α-Fe2O3 composites modified carbon paste electrode for the sensitive electrochemical detection of loperamide: A detailed investigation. Journal of Electroanalytical Chemistry 783, pages 112-124.
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Stanley Nattel. (2016) An Emerging Malignant Arrhythmia Epidemic Due to Loperamide Abuse. JACC: Clinical Electrophysiology 2:7, pages 790-792.
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William Eggleston, Jeanna M Marraffa, Christine M Stork, Maria Mercurio-Zappala, Mark K Su, Rachel S Wightman, Karen R Cummings & Joshua G Schier. (2016) Notes from the Field : Cardiac Dysrhythmias After Loperamide Abuse — New York, 2008–2016 . MMWR. Morbidity and Mortality Weekly Report 65:45, pages 1276-1277.
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PATRICIA VAUGHN, MICHELLE M. K. SOLIK, SHIV BAGGA & BENZY J. PADANILAM. (2016) Electrocardiographic Abnormalities, Malignant Ventricular Arrhythmias, and Cardiomyopathy Associated With Loperamide Abuse. Journal of Cardiovascular Electrophysiology 27:10, pages 1230-1233.
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Charles W. O’Connell, Amir A. Schricker, Aaron B. Schneir, Imir G. Metushi, Ulrika Birgersdotter-Green & Alicia B. Minns. (2016) High-dose loperamide abuse–associated ventricular arrhythmias. HeartRhythm Case Reports 2:3, pages 232-236.
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Kirby Welston & Dianne May. 2016. A Worldwide Yearly Survey of New Data in Adverse Drug Reactions. A Worldwide Yearly Survey of New Data in Adverse Drug Reactions 379 393 .

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