{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T06:00:11Z","timestamp":1773381611859,"version":"3.50.1"},"reference-count":11,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2015,2,3]],"date-time":"2015-02-03T00:00:00Z","timestamp":1422921600000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2015,2]]},"abstract":"<jats:p>Loperamide is an antidiarrheal medication deemed by the U.S. Food and Drug Administration as safe enough to be sold as an over\u2010the\u2010counter medicine. Unlike other \u03bc\u2010opioid receptor agonists, loperamide acts specifically in the myenteric plexus in the gastrointestinal tract, making the potential for abuse low and reports of toxicity extremely rare. We present a case of a patient previously in good health who developed episodes of cardiac pauses, nonsustained ventricular tachycardia, and eventually runs of sustained ventricular tachycardia with hemodynamic instability. She required cardiopulmonary resuscitation, multiple cardioversions, and placement of a pacemaker. Her medical history was remarkable only for type 2 diabetes and chronic postcholecystectomy diarrhea. Metformin was the only prescription medication she was taking at the time of presentation. However, she reported that she had been taking an entire bottle of Equate brand loperamide (144\u00a0mg) daily for ~2\u00a0years. Loperamide overdoses associated with ventricular arrhythmias have been reported, but this is the first case to describe a serious ventricular arrhythmia associated with long\u2010term use of a high dose of loperamide. Chronic overtreatment with loperamide may induce life\u2010threatening arrhythmias.<\/jats:p>","DOI":"10.1002\/phar.1540","type":"journal-article","created":{"date-parts":[[2015,2,3]],"date-time":"2015-02-03T00:59:43Z","timestamp":1422925183000},"page":"234-238","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Ventricular Tachycardia Associated with High\u2010Dose Chronic Loperamide Use"],"prefix":"10.1002","volume":"35","author":[{"given":"Hannah L.","family":"Spinner","sequence":"first","affiliation":[{"name":"Department of Pharmacy University of Utah Health Care Salt Lake City Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nick W.","family":"Lonardo","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Utah Health Care Salt Lake City Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roja","family":"Mulamalla","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine University of Utah Health Care Salt Lake City Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josef","family":"Stehlik","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine University of Utah Health Care Salt Lake City Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,2,3]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"crossref","first-page":"e385","DOI":"10.1161\/CIRCULATIONAHA.106.178233","article-title":"ACC\/AHA\/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology\/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) [developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society]","volume":"114","author":"Zipes DP","year":"2006","journal-title":"Circulation"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2011.06.001"},{"key":"e_1_2_5_4_1","unstructured":"Lexicomp Online.Lexi\u2010Drugs. Hudson Ohio;Lexi\u2010Comp Inc.; July 11 2014."},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.3109\/15563659709001159"},{"issue":"12","key":"e_1_2_5_6_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/01.ccm.0000425416.95852.ed","article-title":"Ventricular tachycardia storm\u2014can it be a side effect from over the counter anti\u2010diarrheal?","volume":"40","author":"Boppana VS","year":"2012","journal-title":"Crit Care Med"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ccm.0000440506.29056.c1"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1126\/scisignal.2000723"},{"key":"e_1_2_5_9_1","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/S0022-3565(25)21735-9","article-title":"Loperamide: blockade of calcium channels as a mechanism for antidiarrheal effects","volume":"231","author":"Reynolds IJ","year":"1984","journal-title":"J\u00a0Pharmacol Exp Ther"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1067\/mcp.2000.109156"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0041-008X(03)00372-7"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/003591576505800503"}],"container-title":["Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fphar.1540","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fphar.1540","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.1540","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T13:47:26Z","timestamp":1761054446000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/phar.1540"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,2]]},"references-count":11,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2015,2]]}},"alternative-id":["10.1002\/phar.1540"],"URL":"https:\/\/doi.org\/10.1002\/phar.1540","archive":["Portico"],"relation":{},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"value":"0277-0008","type":"print"},{"value":"1875-9114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,2]]},"assertion":[{"value":"2015-02-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}