Serotonin Syndrome Developing Immediately after the Initiation of Low-Dose Methadone Therapy: A Case Report

Kumai, Masayoshi; Maeda, Yoshitaka; Miura, Mototsugu; Tsuruga, Kenkichi; Yamada, Takehiro; Takekuma, Yoh; Sugawara, Mitsuru

doi:10.1159/000506443

Cited by 7 publications

(4 citation statements)

References 9 publications

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“…The risk is increased for patients taking antidepressant medications or who receive methadone in combination with other medications frequently used perioperatively, including fentanyl, tramadol, meperidine, and antipsychotic medications. 36,37 Early patient discharge for ERAS protocols makes the diagnosis and treatment of these adverse effects challenging.…”

Section: Adverse Effectsmentioning

confidence: 99%

Pro-Con Debate: Role of Methadone in Enhanced Recovery After Surgery Protocols—Superior Analgesic or Harmful Drug?

D’Souza

Esfahani²,

Dunn

2023

Anesthesia &Amp; Analgesia

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Enhanced recovery after surgery (ERAS) protocols are standardized and designed to provide superior analgesia, reduce opioid consumption, improve patient recovery, and reduce hospital length of stay. Yet, moderate-to-severe postsurgical pain continues to afflict over 40% of patients and remains a major priority for anesthesia research. Methadone administration in the perioperative setting may reduce postoperative pain scores and have opioid-sparing effects, which may be beneficial for enhanced recovery. Methadone possesses a multimodal profile consisting of µ-opioid agonism, N-methyl-d-aspartate (NMDA) receptor antagonism, and reuptake inhibition of serotonin and norepinephrine. Furthermore, it may attenuate the development of chronic postsurgical pain. However, caution is advised with perioperative use of methadone in specific high-risk patient populations and surgical settings. Methadone's wide pharmacokinetic variability, opioid-related adverse effects, and potential negative impact on cost-effectiveness may also limit its use in the perioperative setting. In this PRO-CON commentary article, the authors debate whether methadone should be incorporated in ERAS protocols to provide superior analgesia with no increased risks.

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Section: Adverse Effectsmentioning

confidence: 99%

Pro-Con Debate: Role of Methadone in Enhanced Recovery After Surgery Protocols—Superior Analgesic or Harmful Drug?

D’Souza

Esfahani²,

Dunn

2023

Anesthesia &Amp; Analgesia

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“…Of relevance to the presented case, the phenylpiperidine opioids (including methadone) and many antidepressants (including duloxetine) [2,3,7,12,13] act as serotonin reuptake inhibitors and have been implicated in serotonin syndrome. Methadone has been found to lead to serotonin syndrome even after one dose in a patient on duloxetine and oxycodone [13]. Numerous drugs including opioids are also linked to serotonin syndrome though the evidence is not as robust [7,12].…”

Section: Discussionmentioning

confidence: 99%

“…In particular, there are several drugs that increase the concentration of or amplify the effects of serotonin and predispose a patient to serotonin syndrome [2][3][4][5][6][7]12,13]. Of relevance to the presented case, the phenylpiperidine opioids (including methadone) and many antidepressants (including duloxetine) [2,3,7,12,13] act as serotonin reuptake inhibitors and have been implicated in serotonin syndrome. Methadone has been found to lead to serotonin syndrome even after one dose in a patient on duloxetine and oxycodone [13].…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Considerations in Chronic Serotonin Syndrome: A Case Report

Uday¹,

Qi²,

Wang³

2022

Transl Perioper & Pain Med

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An elderly patient with depression and chronic back pain presents with several months of new onset agitation, insomnia, hyperhidrosis, hypertension, tachycardia, nausea, and vomiting. Her pain quality is unchanged, and basic labs and imaging including cardiac echocardiography are normal. Notably, her medication regimen includes opioids and anti-depressants raising concern for chronic serotonin syndrome. Here, we review the diagnosis of serotonin syndrome and therapeutic considerations for management of the challenging condition.

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“…Symptoms of "serotonin syndrome" are manifested in the form of changes in mental state, autonomic instability, neuromuscular dysfunction, inhibition of the function of the organs of the gastrointestinal tract, etc. [21].…”

mentioning

confidence: 99%

The causes of hospital mortality in methadone associated poisonings: analysis of the data from the Kyiv toxicological center for 2005–2019

Kurdil

2021

UJMTA

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Scientific interest in poisoning by synthetic opioids, in particular Methadone, is due to a significant increase in their number in Kyiv over the past 15 years and fatal consequences. The Aim of the Research. Is to identify the causes of fatal poisoning associated with methadone and to determine measures to prevent them. Materials and Methods. A retrospective analysis of medical data of 1340 patients with Methadone poisoning who were treated at the Toxicology Center in Kyiv in the period 2005–2019; including 38 fatalities cases. Results. The share of drug poisonings registered at the Kyiv Toxicology Center has increased from 15% to 42% over the past 30 years. The top five drugs and psychotropic substances in 2019 were Benzodiazepines, Methadone, Barbiturates, Amphetamines, and Marijuana. The number of Methadone poisonings in 2005–2014 increased 150 times. The main cause of poisoning is the use of illegal Methadone. There is a direct relationship between the growth of hospital mortality and the appearance of combined poisonings: Methadone-Ethanol (r = 0,79); Methadone-Ethanol-Amphetamines (r = 0,69); Methadone-Ethanol-Benzodiazepines (r = 0,61); Methadone-Ethanol-Cocaine (r = 0,43). According to the results of forensic medical studies of 38 patients who died as a result of Methadone poisoning, the following were identified: toxic hepato-nephropathy – 12 cases (31,57%); long-term soft tissue compression syndrome – 10 (26,31%); acute kidney damage – 4 (10,52%); aspiration of gastric contents – 7 (18,42%); apallic syndrome – 4 (10,52%). The direct effect of polymorbidity on mortality has been confirmed, which justifies the need for a personalized approach to intensive care. Conclusions. Today in Ukraine, combined illegal methadone poisoning is the most common type of drug poisoning, which has a severe course, high mortality, and requires long and complex treatment. Key Words: acute poisoning, methadone, combined poisoning, mortality.

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Serotonin Syndrome Developing Immediately after the Initiation of Low-Dose Methadone Therapy: A Case Report

Cited by 7 publications

References 9 publications

Pro-Con Debate: Role of Methadone in Enhanced Recovery After Surgery Protocols—Superior Analgesic or Harmful Drug?

Pro-Con Debate: Role of Methadone in Enhanced Recovery After Surgery Protocols—Superior Analgesic or Harmful Drug?

Therapeutic Considerations in Chronic Serotonin Syndrome: A Case Report

The causes of hospital mortality in methadone associated poisonings: analysis of the data from the Kyiv toxicological center for 2005–2019

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