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Severe opioid withdrawal precipitated by Vivitrol®
R S Wightman1, L S Nelson2, J D Lee3
1Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Brown Emergency Medicine, Providence, RI, 02903, USA.
The American Journal of Emergency Medicine
|April 2, 2018
Summary
Severe precipitated opioid withdrawal (POW) can occur with extended-release naltrexone (XRNTX). Management is challenging, highlighting the need for adherence to protocols to minimize risks during XRNTX treatment.
Area of Science:
- Pharmacology
- Emergency Medicine
- Addiction Treatment
Background:
- Extended-release naltrexone (XRNTX) is FDA-approved for preventing opioid and alcohol relapse.
- Long-acting opioid antagonists can amplify the risk of severe precipitated opioid withdrawal (POW).
Observation:
- Two distinct cases of XRNTX-precipitated POW are presented, showcasing varied patient responses.
- Case 1: A woman experienced hypertensive emergency requiring intensive care after XRNTX re-initiation post-relapse.
- Case 2: A man developed agitation and altered mental status, necessitating intubation, after receiving XRNTX during continued heroin use.
Findings:
- Precipitated opioid withdrawal from XRNTX presents significant management challenges for emergency providers.
- Existing protocols for managing XRNTX-induced POW are lacking.
- Recommended treatments include IV fluids, anti-emetics, clonidine, benzodiazepines, and organ-specific supportive care.
Implications:
- Adherence to manufacturer warnings and clinic protocols, including naloxone challenge and ensuring an adequate opioid-free period, is crucial before administering XRNTX.
- Standardized management protocols for XRNTX-precipitated POW are needed to improve patient outcomes.
- Understanding the diverse clinical presentations of XRNTX-induced POW is essential for effective emergency care.
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