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A myoclonic reaction with low-dose hydromorphone
Seema Patel1, Veda R Roshan, Kelly C Lee
1School of Pharmacy, Loma Linda University, Loma Linda, CA 92350-0001, USA.
The Annals of Pharmacotherapy
|October 19, 2006
Summary
This case report details a patient experiencing myoclonus, or jerking movements, after receiving low-dose hydromorphone. Symptoms resolved upon medication discontinuation, highlighting potential neuroexcitatory effects even without renal impairment.
Area of Science:
- Neuroscience
- Pharmacology
- Clinical Medicine
Background:
- Opioid analgesics like hydromorphone are commonly used for pain management.
- Hydromorphone-3-glucuronide, a metabolite, is known to cause neuroexcitatory effects.
- Myoclonus is typically associated with chronic, high-dose hydromorphone use in patients with renal dysfunction.
Observation:
- A 55-year-old male with hypertrophic cardiomyopathy developed severe chest pain.
- Intravenous hydromorphone was administered at low doses (4 mg on day 1, 6 mg on day 2).
- The patient exhibited uncontrollable jerking movements (myoclonus) shortly after hydromorphone administration.
Findings:
- Myoclonic symptoms ceased rapidly after discontinuing hydromorphone.
- The Naranjo probability scale suggested hydromorphone as the probable cause.
- This case is unique due to the short duration of hydromorphone use and absence of renal dysfunction.
Implications:
- Hydromorphone can induce neuroexcitatory effects, including myoclonus, at relatively low doses.
- Patients without renal dysfunction may be susceptible to these adverse effects.
- Early identification and cessation of hydromorphone are crucial for symptom resolution.
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