{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T10:04:54Z","timestamp":1789034694424,"version":"build-2803163510"},"reference-count":14,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,6,26]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:p>A young man presented to the emergency department with seizures and recurrent episodes of polymorphic ventricular tachycardia (PMVT)\/torsades de pointes (TdP) requiring cardioversion and administration of intravenous magnesium. A battery of tests performed to identify a cause for his arrhythmias and seizures were all normal. A revisit of history with family revealed he had consumed over 100 tablets\/day of loperamide for the past 1\u2009year. A prolonged QT interval on his ECG raised concerns for long QT syndrome (LQTS) (congenital or acquired). Our patient was suspected to have loperamide-induced cardiotoxicity. TdP is a specific PMVT that occurs with a prolonged QT interval and is usually drug-induced. Less frequently, congenital LQTS may be implicated. With supportive care, including mechanical ventilation, vasopressors and temporary transvenous overdrive pacing, our patient recovered completely. We describe the importance of a systematic and time-sensitive approach to diagnosing critical illness. Loperamide overdose may cause QT prolongation, life-threatening arrhythmias\/cardiogenic shock, or cardiac arrest. Seizures\/epilepsy may also be a manifestation in young patients. There is a substantial need to revisit the safety of over-the-counter medications and increasing awareness of manifestations of drug overdose.<\/jats:p>","DOI":"10.1136\/bcr-2021-243325","type":"journal-article","created":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T13:01:35Z","timestamp":1626872495000},"page":"e243325","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Loperamide-induced cardiotoxicity: a case overlooked?"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2406-0855","authenticated-orcid":false,"given":"Sameen","family":"Iqbal","sequence":"first","affiliation":[{"name":"Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4381-9342","authenticated-orcid":false,"given":"Sidra Malik","family":"Fayyaz","sequence":"additional","affiliation":[{"name":"Section of Pulmonology & Critical Care Medicine, Department of Medicine, The Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9408-6084","authenticated-orcid":false,"given":"Yawer","family":"Saeed","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masooma","family":"Aqeel","sequence":"additional","affiliation":[{"name":"Section of Pulmonology & Critical Care Medicine, Department of Medicine, The Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,7,21]]},"reference":[{"key":"2025082801310161000_14.7.e243325.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2012.11.003"},{"key":"2025082801310161000_14.7.e243325.2","doi-asserted-by":"publisher","DOI":"10.1038\/nature04710"},{"key":"2025082801310161000_14.7.e243325.3","doi-asserted-by":"crossref","first-page":"1716.e1711","DOI":"10.1016\/j.ajem.2018.05.027","article-title":"Should loperamide still be an over the counter medication?","volume":"36","author":"Idris","year":"2018","journal-title":"Am J Emerg Med"},{"key":"2025082801310161000_14.7.e243325.4","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2019-232823","article-title":"A tale of twists: loperamide-induced torsades de pointes and ventricular tachycardia storm","volume":"13","author":"Sahu","year":"2020","journal-title":"BMJ Case Rep"},{"key":"2025082801310161000_14.7.e243325.5","doi-asserted-by":"publisher","DOI":"10.4065\/73.3.250"},{"key":"2025082801310161000_14.7.e243325.6","doi-asserted-by":"publisher","DOI":"10.1093\/jat\/29.7.750"},{"key":"2025082801310161000_14.7.e243325.7","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0204443","article-title":"Is there such a thing as a 'lope' dope? 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