The Drug-Induced Respiratory Disease Website

Loperamide

Takotsubo (stress) cardiomyopathy

Cases have also been described following drug overdose (PMID 25172356) or withdrawal (24170890)

Publications

Akel T, Bekheit S

Loperamide cardiotoxicity: "A Brief Review".

Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc 2018 Mar;23;e12505 — 2018 Mar — e12505

Patel KM, Shah S, Subedi D

Takotsubo-Like Cardiomyopathy After Loperamide Overdose.

American journal of therapeutics 2018 Sep/Oct;25;e548-e550 — 2018 Sep/Oct — e548-e550

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

Diagnosing DIRD

Identify causative drugs

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