A commentary on operamide and cardiotoxicity

The Letter uncovers an issue which is increasingly relevant in Community Hospital practice. The authors have highlighted the following points with an interesting case and adequate referencing, but the points are relatively well reported and not novel. There has been a clearly documented increase in the number of reported cases of loperamide abuse and toxicity in the literature in recent years. There is a relatively clear established link between loperamide use and cardiotoxicity. The cardiotoxic effects more commonly reported include QTc prolongation and QRS interval prolongation with concomitant ventricular arrythmias. There has also been an increase in popular awareness regarding the abuse potential of loperamide which has entered the public domain. The increased abuse of loperamide may be related to the general trend of restricting prescriptions of controlled substances A few additional points that may be brought to the authors attention: