A Rare Case of Loperamide-Induced Cardiac Arrest.

Loperamide (Imodium) is an opioid receptor agonist available over-the-counter and can be used for the treatment of diarrhea. When ingested in excessive doses, loperamide can penetrate the blood-brain barrier and is reported to produce euphoria, depression of the central nervous system, and cardiotoxicity. It may also be used for its euphoric effects and potentially to alleviate opioid withdrawal. Loperamide has a US boxed warning for torsades de pointes and sudden death. Loperamide has been reported to cause torsades de pointes, cardiac arrest, and death when higher than the recommended dosage is consumed. We report a rare case of ventricular arrhythmia provoked by accidental ingestion of loperamide to treat simple diarrhea.

A Case of Dronedarone-Induced Hypotensive Shock.

Atrial fibrillation (AF) is the most common cardiac arrhythmia. Dronedarone is a new antiarrhythmic used for rhythm and rate control in AF and is associated with reduced mortality in non-permanent AF. It has also been associated with increased mortality in those with heart failure and/or permanent AF. This case report presents the case of hypotensive shock after initiating treatment with dronedarone in a 73-year-old female patient. Shortly after her first dose of dronedarone, she developed hypotension that did not respond to intravenous fluids and was admitted to the intensive care unit for vasopressor administration. Dronedarone was the most likely cause of the hypotension as the patient's blood pressure normalized in 24 hours, which concurs with the half-life of dronedarone. Amiodarone and dronedarone are similar in composition; however, the absence of iodine moieties in dronedarone contributes to its improved side-effect profile. Furthermore, amiodarone has been linked to hypotensive shock likely due to a co-solvent used in some intravenous preparations; however, dronedarone-induced hypotension is less common.