Naldemedine-induced opioid withdrawal syndrome with severe psychiatric symptoms in an advanced cervical cancer patient without brain metastasis
Naldemedine-induced opioid withdrawal syndrome with severe psychiatric symptoms in an advanced cervical cancer patient without brain metastasis
复制标题
纳尔德米定导致无脑转移的晚期宫颈癌患者出现阿片类药物戒断综合征并伴有严重精神症状
DOI：
10.1017/s1478951521001917
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发表时间：
2021
影响因子：
2.2
通讯作者：
Onishi Hideki
中科院分区：
文献类型：
--
作者：
Ishida Mayumi;Hiraoka Mie;Yaguchi Ayako;Sugano Koji;Adachi Nasako;Itoga Tomoko;Ishiguro Tomohito;Onishi Hideki
目的研究口服外周μ-阿片受体拮抗剂阿尔地麦定治疗阿片类药物引起的便秘。Naldemedine通常不被认为是引起阿片类戒断的原因，其相关症状影响中枢神经系统。方法从一系列接受症状管理的癌症患者中，我们报告了一例使用纳德美定治疗与阿片类药物治疗癌症疼痛相关的便秘，并在使用纳德美定后立即出现严重的戒断相关心理症状。结果36岁，女性，宫颈癌IIB期，PS3期。患者使用盐酸羟可酮（80 mg/天）治疗回肠疼痛，开始使用纳德美定治疗便秘，5分钟后出现出汗，1小时后出现幻觉。患者还表现出腹泻、多动等身体/行为异常，以及对工作人员的攻击等心理异常。尽管精神症状随着时间的推移而加重，但血液生化数据未见异常，MRI未见脑转移。根据临床阿片类药物戒断量表，判断这些症状为阿片类药物戒断。由于存在与纳地美定相关的阿片类戒断综合征，停用了纳地美定，此后精神症状减轻，迄今未观察到类似症状复发。结果的意义如果服用纳地美定的患者出现精神和行为异常，有必要考虑阿片戒断综合征的可能性作为鉴别诊断。
ObjectiveNaldemedine, an oral peripheral μ-opioid receptor antagonist, was developed for the treatment of constipation, a side effect of opioid use. Naldemedine is not generally recognized as causing opioid withdrawal in which associated symptoms affecting the central nervous system.MethodFrom the series of cancer patients undergoing symptom management, we report a case treated with naldemedine for constipation in relation to the use of opioids for cancer pain and who displayed severe psychological symptoms associated with withdrawal immediately after the use of naldemedine.ResultsThe patient was a 36-year-old woman diagnosed with cervical cancer Stage IIB, PS3. When the patient, who was using oxycodone hydrochloride hydrate (80 mg/day) for ileal pain, was started on naldemedine for constipation, she complained of sweating after just 5 min and hallucinations after 1 h. The patient also displayed physical/behavioral abnormalities such as diarrhea and hyperactivity, and psychological abnormalities such as aggression toward staff.Despite the psychiatric symptoms worsening over time, there were no abnormalities in terms of blood biochemical data, and no brain metastasis was observed on MRI. Based on the Clinical Opiate Withdrawal Scale, these symptoms were judged to indicate opioid withdrawal. Naldemedine was discontinued due to naldemedine-related opioid withdrawal syndrome and, thereafter, the psychiatric symptoms diminished, with no recurrence of similar symptoms observed to date.Significance of resultsIf mental and behavioral abnormalities occur in patients receiving naldemedine, it is necessary to consider the possibility of opioid withdrawal syndrome as a differential diagnosis.
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影响因子：
1.2
作者：
Ishii, Koji;Yamashita, Haruna;Hara, Tetsuya
通讯作者：
Hara, Tetsuya
影响因子：
2.8
作者：
Wesson, DR;Ling, W
通讯作者：
Ling, W
影响因子：
45.3
作者：
Katakami, Nobuyuki;Harada, Toshiyuki;Boku, Narikazu
通讯作者：
Boku, Narikazu
影响因子：
7.4
作者：
Webster LR;Nalamachu S;Morlion B;Reddy J;Baba Y;Yamada T;Arjona Ferreira JC
通讯作者：
Arjona Ferreira JC