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
Summary
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.
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