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ACMT Toxicology Visual Pearls: Drug-Induced QT Prolongation

2017-10-23T12:33:15+00:00

Which over-the-counter medication can be associated with these EKG findings in overdose?

  1. Aspirin
  2. Guaifenesin
  3. Loperamide
  4. Pseudoephedrine
  5. Senna


Reveal the Answer

This post was peer-reviewed by Dr. Ziad Kazzi, Dr. Bryan Judge, and Dr. Louise Kao.

The American College of Medical Toxicology (ACMT) hosts this Toxicology Visual Pearls series
1.
Swank K, Wu E, Kortepeter C, McAninch J, Levin R. Adverse event detection using the FDA post-marketing drug safety surveillance system: Cardiotoxicity associated with loperamide abuse and misuse. J Am Pharm Assoc (2003). 2017;57(2S):S63-S67. [PubMed]
2.
Kang J, Compton D, Vaz R, Rampe D. Proarrhythmic mechanisms of the common anti-diarrheal medication loperamide: revelations from the opioid abuse epidemic. Naunyn Schmiedebergs Arch Pharmacol. 2016;389(10):1133-1137. [PubMed]
3.
Othong R, Devlin J, Kazzi Z. Medical toxicologists’ practice patterns regarding drug-induced QT prolongation in overdose patients: a survey in the United States of America, Europe, and Asia Pacific region. Clin Toxicol (Phila). 2015;53(4):204-209. [PubMed]
4.
Al-Khatib S, LaPointe N, Kramer J, Califf R. What clinicians should know about the QT interval. JAMA. 2003;289(16):2120-2127. [PubMed]
Ryan Marino, MD

Ryan Marino, MD

Toxicology Fellow
Department of Emergency Medicine
University of Pittsburgh Medical Center
Ryan Marino, MD

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Anthony Pizon, MD, FACMT

Anthony Pizon, MD, FACMT

Associate Professor of Emergency Medicine
Chief of Toxicology Division, Department of Emergency Medicine
Program Director, Toxicology Fellowship
University of Pittsburgh Medical Center
Anthony Pizon, MD, FACMT

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  • Jeremy Rohrlich

    Great case. Expect to see more of this with the growing epidemic and fewer opioid prescriptions written. Wanted to mention that when I clicked on the ECG to enlarge it, it pops up in a window titled “Loperamide-QT”, which kind of spoils the fun. Keep up the good work! Jeremy Rohrlich MD

    • Academic Life in EM

      Excellent catch, thank you! This should be resolved now. Much appreciation,
      Derek Monette, MD, ALiEM Dep EIC