Narcotic Withdrawal Syndrome Caused by Naltrexone

Tornabene, Vincent W.

doi:10.7326/0003-4819-81-6-785

Cited by 21 publications

(3 citation statements)

References 3 publications

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“…Acting as a competitive antagonist, naloxone binds to and blocks the μ opioid receptor, leading to withdrawal symptoms in frequent users of opioids (2). In contrast with adults, children almost never exhibit opioid tolerance, so precipitation of withdrawal is not a concern.…”

Section: Discussionmentioning

confidence: 99%

Opiate-Positive Immunoassay Screen in a Pediatric Patient

Straseski¹,

Stolbach

Clarke³

2010

Clinical Chemistry

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CASEA 3-year-old girl was transferred from an outside hospital to the emergency department after being found shivering and unattended outside of a public shopping area in winter. She presented with decreased mental status and possible hypothermia; she was lethargic and slipped in and out of consciousness. No cause for this alteration in her mental state was obvious; however, a physical examination revealed multiple abrasions and bruises. The patient had a temperature of 37°C, a blood pressure of 134/74 mmHg, a heart rate of 103 beats/min, and a respiratory rate of 24 breaths/min. Computed tomography scans, a skeletal survey, and an ophthalmologic examination did not reveal additional injuries. An intravenous bolus of the opioid antagonist naloxone (Narcan) was administered shortly after her arrival in the emergency department.Routine hematology and chemistry tests were performed and revealed decreased serum urea nitrogen, along with increased lactate, aspartate aminotransferase, and alanine aminotransferase (Table 1). Serum acetaminophen and salicylate were not detected, and blood carboxyhemoglobin was not increased. Urine and stool cultures were negative, as was a nasal swab for methicillin-resistant Staphylococcus aureus. Toxicologic screening of a urine sample collected upon the girl's arrival in the emergency department detected no amphetamines, barbiturates, benzodiazepines, cocaine metabolite, opiates (codeine and morphine), tetrahydrocannabinol (marijuana), or methodone. A gas chromatographic screen for volatile substances in the patient's serum did not detect ethanol, methanol, or isopropyl alcohol but was positive for acetone. She was admitted to a pediatric floor for further monitoring.Early the next day, clinicians requested a second urine toxicology immunoassay screen. This sample was positive for opiates at a cutoff of 300 g/L. Confirmatory testing by GC-MS was negative for codeine, hydrocodone, oxycodone, morphine, hydromorphone, and oxymorphone (100-g/L cutoff). A repeat immunoassay in our laboratory substantiated the original positive opiate result, and further investigation was initiated.

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Section: Discussionmentioning

confidence: 99%

Opiate-Positive Immunoassay Screen in a Pediatric Patient

Straseski¹,

Stolbach

Clarke³

2010

Clinical Chemistry

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“…Before starting naltrexone, patients should discontinue narcotics for a minimum of 7-10 days. Patients who are addicted to narcotics should be detoxified prior to naltrexone administration to avoid withdrawal symptoms (Tornabene, 1974). There is some evidence that naltrexone may worsen symptoms of alcohol withdrawal, such as nausea and possibly affective instability (O'Malley, 1995).…”

Section: Pharmacotherapy Of Alcohol Use Disorders 2009mentioning

confidence: 99%

Pharmacotherapy of Alcohol Use Disorders

Buonopane

Petrakis

2005

Substance Use & Misuse

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Therapeutic interventions to treat alcoholism have increased in number, including several pharmacotherapies. Aspects of epidemiology, gender, and psychiatric comorbidity as well as a brief overview of neurobiology are presented as an introduction. The medications used clinically for the treatment of alcoholism, disulfiram and naltrexone, approved by the Food and Drug Administration in the United States for the treatment of alcoholism and acamprosate, a medication used extensively in Europe that is currently being evaluated in the United States, are reviewed in detail. An overview of the serotonergic agents is also provided. Finally, future directions, including new medications and some clinical strategies that show promise but are not yet used extensively clinically, are mentioned.

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“…Nevertheless, it is contraindicated in advanced liver disease. In addition, because of risk of severe withdrawal, NTX may not be provided in patients using opioids . Long‐acting injectable formulations of NTX were introduced to improve the medication compliance, allowing a monthly dosing of drug.…”

Section: Abstinencementioning

confidence: 99%

Pharmacotherapy of alcoholic liver disease in clinical practice

et al. 2015

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Abstinence remains the cornerstone of ALD therapy but it is also the most difficult therapeutic target to achieve and the risk of recidivism is very high at any time. Several drugs (disulfiram, naltrexone, acamprosate, sodium oxybate) have proven to be effective to prevent alcohol relapse and increase the abstinence, although the psychotherapeutic support remains crucial. Baclofen seems to be effective to improve abstinence, showing an excellent safety and tolerability. ALD is often complicated by a state of malnutrition, which is related to a worst mortality. A nutritional therapy may improve survival in cirrhotic patients, reversing muscle wasting, weight loss and specific nutritional deficiencies. While in aggressive forms of alcoholic hepatitis are recommended specific drug treatments, including glucocorticoids or pentoxifylline, for the long-term treatment of ALD, specific treatments aimed at stopping the progression of fibrosis are not yet approved, but there are some future perspective in this field, including probiotics and antibiotics, caspase inhibitors, osteopontin and endocannabinoids.

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Narcotic Withdrawal Syndrome Caused by Naltrexone

Cited by 21 publications

References 3 publications

Opiate-Positive Immunoassay Screen in a Pediatric Patient

Opiate-Positive Immunoassay Screen in a Pediatric Patient

Pharmacotherapy of Alcohol Use Disorders

Pharmacotherapy of alcoholic liver disease in clinical practice

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