Diagnosis and Treatment of Presumed Naltrexone-XR-precipitated Opioid Withdrawal in a Patient Chronically Treated With Buprenorphine-XR: A Case Report.

IF 4.2 3区医学 Q1 SUBSTANCE ABUSE

Journal of Addiction Medicine Pub Date : 2024-11-01 Epub Date: 2024-07-05 DOI:10.1097/ADM.0000000000001342

Jessica Moore, Kalvin Foo, Ernest Egu, Xin Gao, Rachel Ehrman-Dupre, Matthew Salzman

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引用次数: 0

Abstract

Abstract: Naltrexone, buprenorphine, and methadone are Food and Drug Administration-approved medications for the treatment of opioid use disorder in the United States. Naltrexone, an opioid antagonist, can precipitate opioid withdrawal if administered too quickly after the use of full or partial opioid agonists for those with either dependence or use disorder. We describe a case of severe precipitated opioid withdrawal syndrome after reported buprenorphine extended-release (XR) administration, despite the patient having been stable on buprenorphine-XR for several years, with no missed doses or recent opioid use. Naltrexone levels were sent and helped to diagnose suspected inadvertent naltrexone-XR administration in this patient, which was likely the etiology of his precipitated opioid withdrawal syndrome. We suggest the use of high-dose buprenorphine, as well as adjunctive medications including benzodiazepines, as a treatment strategy for naltrexone-XR precipitated withdrawal in the setting of chronic buprenorphine-XR treatment.

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一名长期接受丁丙诺啡-XR 治疗的患者因服用纳曲酮-XR 而出现阿片类药物戒断的诊断和治疗：病例报告。

摘要：纳曲酮、丁丙诺啡和美沙酮是美国食品和药物管理局批准用于治疗阿片类药物使用障碍的药物。纳曲酮是一种阿片类药物拮抗剂，如果在有阿片类药物依赖或使用障碍的患者使用完全或部分阿片类药物激动剂后过早给药，可能会诱发阿片类药物戒断。我们描述了一例在使用丁丙诺啡缓释剂（XR）后出现严重阿片类药物戒断综合征的病例，尽管患者使用丁丙诺啡缓释剂（XR）已有数年，病情稳定，没有漏服或近期使用过阿片类药物。送检的纳曲酮水平有助于诊断该患者疑似无意中服用了纳曲酮-XR，这很可能是导致其阿片类药物戒断综合征的病因。我们建议使用大剂量丁丙诺啡以及包括苯二氮卓类药物在内的辅助药物，作为慢性丁丙诺啡-XR 治疗背景下纳曲酮-XR 诱发戒断的治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Addiction Medicine 医学-药物滥用

CiteScore

6.10

自引率

9.10%

发文量

260

审稿时长

>12 weeks

期刊介绍： The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.