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
| d. | Pulse oximetry |
|---|
Stabilize the airway and provide supplemental oxygen, if needed. Establish an airway if patients cannot
protect their airway or have significant respiratory depression.