Nalmefene Mistakenly Prescribed to Reduce Alcohol Consumption in Patients Under Buprenorphine Substitution Therapy Resulting in Acute Opioid Withdrawal

Opioid substitution therapy or hidden opioids are a minefield for nalmefene: an atypical case series of 11 patients in Lorraine

“…No patient died. When documented, the time to onset of the OWS ranged from 1 to 2 h, which is consistent with others observations . In our case series, some symptoms can be related to opioids: pancreatitis, Oddi's sphincter dysfunction (case # 1), or hyperlipasemia (case # 5).…”

“…Our case series is so far the only one involving 11 patients, two of them taking other opioid drugs than methadone and buprenorphine. Previous reports concerned only methadone or buprenorphine as OST , and one case report concerned a patient suffering from a codeine dependence . No published case series referred neither to an analgesic opioid drug nor to an antidiarrheal opioid analog.…”

“…Nalmefene is contraindicated in patients taking opioid agonists (analgesics, opioids substitution therapy [OST]), patients with current or recent opioid addiction (without any precision) , patients with acute symptoms of opioid withdrawal syndrome (OWS), and patients for whom recent use of opioids is suspected . However, despite this contraindication is labeled in the summary of product characteristics (SmPC), and recent warnings from our department and the European authorities , additional cases of OWS in patients treated with opioid agonists have been reported . We aim to report a case series of 11 recent cases and to point out the responsibility of healthcare professionals in tracking more strictly patient consumption of opioids before prescribing nalmefene.…”