Withdrawal syndrome after co-medication of opioid maintenance therapy with nalmefene: unrecognized interaction

Diot, Caroline; Eiden, Céline; Roussin, Anne; Batisse, Anne; Boucher, Alexandra; Chavant, François; Daveluy, Amélie; Donadieu-Rigole, Hélène; Peyrière, Hélène; d’addictovigilance, et le réseau des centres français

doi:10.1007/s00228-015-1931-y

Cited by 8 publications

(7 citation statements)

References 5 publications

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“…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).…”

Section: Discussionsupporting

confidence: 90%

“… A paronymic explanation between nalmefene and baclofene, due to their close consonance . This confusion could be possibly aggravated by the fact that, since 2015, practitioners are strongly encouraged to prescribe in using international nonproprietary name without the brand name. Some healthcare professionals remain probably not well informed about the contraindications and the modifications of the SmPC of SELINCRO ® .…”

Section: Discussionmentioning

confidence: 99%

“…We suggest four explanations for the persistence of these contraindicated prescriptions: 1. A paronymic explanation between nalmefene and baclofene, due to their close consonance [10]. This confusion could be possibly aggravated by the fact that, since 2015, practitioners are strongly encouraged to prescribe in using international nonproprietary name without the brand name.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Yéléhé‐Okouma

Martini²,

Lemarié³

et al. 2017

Fundamemntal Clinical Pharma

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Opioid antagonists such as naltrexone and nalmefene are used in drug therapy for alcoholism. Nalmefene, approved in Europe in February 2013 for the reduction of alcohol consumption, is used in patients with alcohol dependence. We report 11 cases of opioid withdrawal syndrome after a single dose of nalmefene in patients usually treated with methadone, buprenorphine, but also with fentanyl or loperamide. Nalmefene is both a partial agonist and an antagonist of opioid receptors. Regarding to its opioid antagonist activity, nalmefene is contraindicated in patients with an opioid treatment. Therefore, when prescribing or delivering nalmefene, healthcare professionals need to be vigilant about any type of opioid exposure, even masked or hidden, to avoid these potential life-threatening syndromes.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Yéléhé‐Okouma

Martini²,

Lemarié³

et al. 2017

Fundamemntal Clinical Pharma

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Opioid Withdrawal Precipitated by Long-Acting Antagonists

Kunzler

Wightman

Nelson

2020

The Journal of Emergency Medicine

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Drug-drug interactions in the treatment for alcohol use disorders: A comprehensive review

Guerzoni

Pellesi

Pini

et al. 2018

Pharmacological Research

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Drug interactions are one of the most common causes of side effects in polypharmacy. Alcoholics are a category of patients at high risk of pharmacological interactions, due to the presence of comorbidities, the concomitant intake of several medications and the pharmacokinetic and pharmacodynamic interferences of ethanol. However, the data available on this issue are limited. These reasons often frighten clinicians when prescribing appropriate pharmacological therapies for alcohol use disorder (AUD), where less than 15% of patients receive an appropriate treatment in the most severe forms. The data available in literature regarding the relevant drug-drug interactions of the medications currently approved in United States and in some European countries for the treatment of AUD (benzodiazepines, acamprosate, baclofen, disulfiram, nalmefene, naltrexone and sodium oxybate) are reviewed here. The class of benzodiazepines and disulfiram are involved in numerous pharmacological interactions, while they are not conspicuous for acamprosate. The other drugs are relatively safe for pharmacological interactions, excluding the opioid withdrawal syndrome caused by the combination of nalmefene or naltrexone with an opiate medication. The information obtained is designed to help clinicians in understanding and managing the pharmacological interactions in AUDs, especially in patients under multi-drug treatment, in order to reduce the risk of a negative interaction and to improve the treatment outcomes.

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Withdrawal syndrome after co-medication of opioid maintenance therapy with nalmefene: unrecognized interaction

Cited by 8 publications

References 5 publications

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

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

Opioid Withdrawal Precipitated by Long-Acting Antagonists

Drug-drug interactions in the treatment for alcohol use disorders: A comprehensive review

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