부산대학교 도서관

Background: Naltrexone is a long-acting, opiate antagonist used for rapid-opioid detoxification and to prevent recurrence of opioid dependence. Naltrexone was recently made available on general prescription to treat alcohol and opioid dependence in Australia. We report 3 cases of naltrexone-induced opioid withdrawal with associated delirium in patients attempting self-detox without medical supervision. Case-l: 44-year-old M, on 130 mg of methadone daily, presented soon after ingestion of 2 x 50 mg naltrexone tablets obtained from a friend. Exam revealed piloerection, vomiting, agitation, yawning, and confusion. P 70/min, BP 140/80 mmHg, T 36 [degrees] C, RR 30/min. Symptoms resolved over the next 12 hours. Case-2: A 27-year-old F ingested 50 mg naltrexone obtained from her primary care physician (PCP). Last heroin use was 10 hours previously. She complained of nausea, vomiting, diarrhea and abdominal pain. Pulse 90/min, BP 100/50, T 36.5 [degrees] C, RR 25/min, GCS-15. Two hours later disorientation and confusion developed. Symptoms resolved over the next 12 hours. Case-3: 22-year-old M presented 1 hour following ingestion of 50 mg naltrexone prescribed by his PCP. Last heroin use 10 hours earlier. On arrival nausea, vomiting, diarrhea, muscle cramps, yawning, piloerection, disorientation, confusion, and agitation noted. P 60/min, BP 110/60 mmHg, T 36 [degrees] C, RR 30/min, mydriasis. Symptoms persisted for 16 hours. Treatment: All 3 patients received IV fluids, ondansentron, clonidine, and octreotide. Conclusion: Acute withdrawal resulting from naltrexone misuse may be prolonged and severe in opioid-dependent individuals and may include an acute confusional state. Hospital admission will be required to treat prolonged withdrawal symptoms. Widespread availability of naltrexone will likely result in further presentations of severe withdrawal to hospital.
Vassiliadis J, Graudins A, Dowsett RP, Currie J. Departments of Toxicology, Emergency Medicine, and Drug and Alcohol Westmead Hospital Sydney, [...]