Correct!
1. Buprenorphine
Buprenorphine is a partial opioid agonist with highly competitive binding affinity. Buprenorphine is FDA indicated for the management of opioid dependence and prevention of opioid withdrawal.
Methadone is also indicated for opioid dependent patients but would not be the best choice in this scenario due to risk of QT prolongation. If the patient was to relapse and again start abusing loperamide in addition to the methadone, additive effects on QT prolongation would be expected.
Clonidine can be used as an adjunct for patients experiencing acute symptoms of withdrawal but is not indicated for chronic treatment of dependence. Sertraline and cimetidine are not indicated for the treatment of opioid misuse or withdrawal.
References
- Dave J. Torsade de Pointes. Medscape. Jan 31, 2017. Available at: https://emedicine.medscape.com/article/1950863-overview#a1 (accessed 12/14/18).
- Wu PE, Juurlink DN. Clinical review: Loperamide toxicity. Ann Emerg Med. 2017 Aug;70(2):245-52. [CrossRef] [PubMed]
- Nattel S. An emerging malignant arrhythmia epidemic due to loperamide abuse: underlying mechanisms and clinical relevance. JACC Clin Electrophysiol. 2016 Dec;2(7):790-2. [CrossRef] [PubMed]
- Hughes A, Hendrickson RG, Chen BC, Valento M. Severe loperamide toxicity associated with the use of cimetidine to potentiate the "high". Am J Emerg Med. 2018 Aug;36(8):1527.e3-1527.e5. [CrossRef] [PubMed]
- Nickson C. Temporary pacemaker troubleshooting. Life in the Fast Lane. May 17, 2016. Available at: https://lifeinthefastlane.com/ccc/temporary-pacemaker-troubleshooting/ (accessed 12/14/18).
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