Severe opioid withdrawal precipitated by Vivitrol®.
Am J Emerg Med
; 36(6): 1128.e1-1128.e2, 2018 Jun.
Article
in En
| MEDLINE
| ID: mdl-29605483
ABSTRACT
The risk of severe precipitated opioid withdrawal (POW) is amplified when precipitated by a long-acting opioid antagonist. IM extended release naltrexone (XRNTX;Vivitrol®) is an FDA approved therapy to prevent relapse of opioid and alcohol abuse. Two cases of precipitated opioid withdrawal from XRNTX are presented that illustrate different patient reactions to POW. A 56-year-old woman developed a hypertensive emergency and required continuous intravenous vasodilator, clonidine, and intensive care monitoring after re-initiation of XRNTX following opioid relapse. A 25-year-old man developed agitation and altered mental status after receipt of XRNTX at the conclusion of a twelve-day detoxification program during which he continued surreptitious use of heroin. The patient received benzodiazepines and haloperidol without adequate affect, and required intubation with propofol, lorazepam, and dexmedetomidine infusions. Management of POW from XRNTX is a challenge to emergency providers and protocols to guide management do not exist. Recommended therapies include intravenous fluids, anti-emetics, clonidine, or benzodiazepines as well as therapy tailored to the organ system affected. To minimize risk of POW it is important for providers instituting XRNTX to adhere to the manufacturers warnings and clinic protocols including a naloxone challenge and ensure an adequate opioid free period prior to administration of XRNTX.
Key words
Full text:
1
Database:
MEDLINE
Main subject:
Substance Withdrawal Syndrome
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Emergency Medical Services
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Heroin Dependence
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Naltrexone
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Narcotic Antagonists
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Opioid-Related Disorders
Type of study:
Guideline
Limits:
Adult
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Female
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Humans
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Male
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Middle aged
Language:
En
Journal:
Am J Emerg Med
Year:
2018
Type:
Article