Toxicology

Adverse effects are rare and may be more related to a return of sympathetic response to opioid

withdrawal. Nausea and vomiting are common and can lead to aspiration. If the situation

allows, providing assisted manual ventilation prior to administering naloxone can potentiate the

sympathetic response to opioid reversal (Anesth Analg 1988;67:730-6).

If no effect is seen at the higher naloxone doses, consider other causes such as co-ingestants or

alternative agents.

naloxone or discontinuation of the continuous infusion. The duration of a naloxone continuous infusion will

vary based on the quantity, pharmacokinetics, and pharmacodynamics of the opioid exposure, in addition

to patient specific factors. Closely monitor for signs and symptoms of opioid withdrawal syndrome, such as

anxiety, piloerection, heightened sensation to pain, abdominal cramps, diarrhea, and insomnia.

A nonprescription antidiarrheal medication with a 91% increase in reported abuse in 2010-2015 resulting

other agents) accounted for 695 overdoses and 1 death in 2022.

effects

Phenylpiperidine opioid that slows intestinal transit time by stimulating mu-opioid receptors in the GI

tract and blocks intestinal calcium channels

Toxicity of loperamide involves blockade of sodium channels and potassium channels in the cardiac

tissue, causing QT prolongation and QRS interval widening and leading to life-threatening dysrhythmias

and cardiac death

Common signs/symptoms include respiratory depression, nausea, vomiting, decreased level of

consciousness, miosis, decreased bowel motility/ileus, palpitations, and syncope.

interval.

Diagnostic workup

12-lead ECG to assess for QT prolongation and QRS interval widening and development of

ventricular dysrhythmias

Arterial blood gas to monitor for respiratory acidosis secondary to respiratory depression

Standard chemistry panel for electrolyte and glucose abnormalities, plus CK, BUN, and SCr for

signs of rhabdomyolysis

Stabilize the airway and provide supplemental oxygen, if needed. Establish an airway if patients cannot

protect their airway or have significant respiratory depression.