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Unintentional rapid opioid detoxification: case report
Shubh M Singh1, Balkishan Sharma
1Department of Psychiatry, Gian Sagar Medical College and Hospital, Banur, Punjab, India. shubhmohan@gmail.com
Background:
Naltrexone is a competitive opioid antagonist and is often used to maintain abstinence in detoxified opioid dependent patients. However, it can precipitate an accelerated withdrawal when ingested by an individual with concurrent opioid use.
Methods:
We report the case of a 28 year old male with opioid dependence syndrome presenting with chaotic symptoms following ingestion of naltrexone. Symptomatology, management is described and literature in this area is reviewed.
Results:
Accidental or surreptitious ingestion of naltrexone in a patient with concurrent opioid use can precipitate symptoms typical of opioid withdrawal in addition to other varying symptomatology. Most cases would require sedation and management of concurrent vomiting and diarrhoea.
Conclusions:
Clinicians, especially those providing substance abuse and emergency care, need to be aware of the possibility of an accelerated and possibly life threatening withdrawal associated with naltrexone ingestion in an incompletely detoxified patient with opioid dependence.
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Antidotes serve a crucial role in counteracting the effects of poison by inhibiting enzymes responsible for producing harmful drug metabolites. In some cases, these toxic metabolites can be neutralized by endogenous cosubstrates, which are maintained at specific concentrations to prevent interaction with cellular macromolecules and subsequent cell death.
Renal excretion is the...

