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Relapsing thrombotic microangiopathy and intravenous sustained-release oxycodone

Melissa Nataatmadja1, Dakshinamurthy Divi1

  • 1Department of Nephrology , Gold Coast University Hospital , Southport, QLD , Australia.

Clinical Kidney Journal
|August 2, 2016
PubMed

Insights

Injecting sustained-release oxycodone can cause thrombotic microangiopathy (TMA), a serious condition. This case shows relapsing TMA from continued intravenous opioid use, possibly due to polyethylene oxide (PEO) toxicity.

Area of Science:

  • Nephrology
  • Hematology
  • Toxicology

Background:

  • Thrombotic microangiopathy (TMA) has been linked to injecting sustained-release oxymorphone.
  • Intravenous drug use, particularly with modified-release formulations, poses unique health risks.

Purpose of the Study:

  • To report a case of TMA secondary to intravenous sustained-release oxycodone use.
  • To highlight the potential for relapsing TMA with continued intravenous opioid administration.
  • To investigate the role of polyethylene oxide (PEO) in opioid-induced TMA.

Main Methods:

  • Case report detailing clinical presentation, diagnosis, and management of TMA.
  • Review of literature on TMA associated with opioid formulations.
  • Discussion of the suspected mechanism involving polyethylene oxide (PEO).

Main Results:

  • A patient developed TMA following intravenous use of sustained-release oxycodone.
  • The patient experienced relapsing TMA despite treatment, correlating with persistent opioid use.
  • Polyethylene oxide (PEO) is implicated as the likely toxic agent affecting endothelial cells.

Conclusions:

  • Intravenous use of sustained-release oxycodone can precipitate TMA.
  • Relapsing TMA is a risk with ongoing intravenous opioid administration.
  • Genetic predispositions may influence susceptibility to PEO-induced TMA.
Keywords:
Oxycontinoxycodoneplasma exchangepolyethylene oxidethrombotic microangiopathy

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