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Neuropsychiatric side effects due to a transdermal fentanyl patch: hallucinations
Sahin Colak1, Mehmet Ozgür Erdogan1, Mustafa Ahmet Afacan1
1Haydarpasa Numune Training and Research Hospital, Emergency Medicine Clinic, Istanbul, Turkey.
The American Journal of Emergency Medicine
|September 18, 2014
Summary
Opioid analgesics like fentanyl can cause rare central nervous system side effects in end-stage cancer patients. Weight loss and low albumin levels in these patients may increase the risk of fentanyl-induced hallucinations.
Area of Science:
- Oncology
- Pharmacology
- Geriatrics
Background:
- Opioid analgesics are frequently prescribed for pain management in end-stage cancer patients.
- Central nervous system (CNS) adverse effects from opioids are considered rare in this population.
- Palliative care often involves managing complex symptoms, including pain and nausea.
Observation:
- A 73-year-old female patient with end-stage cancer and metastases presented with auditory and visual hallucinations.
- The patient was receiving transdermal fentanyl for pain and metoclopramide for nausea.
- Significant weight loss (10 kg in 5 months) and hypoalbuminemia were noted.
Findings:
- The patient's hallucinations were attributed to a potential fentanyl overdose.
- Discontinuation of the transdermal fentanyl patch led to improvement in symptoms.
- Weight loss and hypoalbuminemia were identified as potential contributing factors to increased opioid susceptibility.
Implications:
- End-stage cancer patients experiencing weight loss and hypoalbuminemia may be at higher risk for opioid-induced CNS adverse effects.
- Fentanyl dosage adjustments are crucial in patients with significant weight loss.
- Addressing hypoalbuminemia may help mitigate the incidence of adverse opioid effects, such as hallucinations.
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