Naldemedine-induced Opioid Withdrawal Syndrome in a Patient with Breast Cancer without Brain Metastasis

Intern Med. 2020 Jan 15;59(2):293-296. doi: 10.2169/internalmedicine.3098-19. Epub 2019 Sep 18.

Abstract

Opioid-induced-constipation (OIC) can be treated by naldemedine and other peripherally acting mu-opioid receptor antagonists (PAMORA) via a novel mechanism. We describe the case of a 52-year-old female outpatient who developed OIC while receiving oxycodone for pain due to cancer with multiple bone metastases. Although she did not have brain metastasis, opioid withdrawal syndrome (OWS) developed after taking naldemedine orally. Her Clinical Opiate-Withdrawal Score (COWS) was 19 (moderate symptoms). However, she recovered from OWS on intravenous fentanyl and a continuous infusion of oxycodone. She did not develop OWS thereafter and was discharged two days after recovery.

Keywords: naldemedine; opioid withdrawal syndrome (OWS); opioid-induced-constipation (OIC).

Publication types

  • Case Reports

MeSH terms

  • Analgesics, Opioid / therapeutic use
  • Breast Neoplasms / pathology
  • Cancer Pain / drug therapy
  • Female
  • Humans
  • Middle Aged
  • Naltrexone / adverse effects
  • Naltrexone / analogs & derivatives*
  • Naltrexone / therapeutic use
  • Narcotic Antagonists / adverse effects*
  • Narcotic Antagonists / therapeutic use
  • Opioid-Induced Constipation / drug therapy*
  • Oxycodone / adverse effects*
  • Oxycodone / therapeutic use
  • Substance Withdrawal Syndrome / drug therapy
  • Substance Withdrawal Syndrome / etiology*

Substances

  • Analgesics, Opioid
  • Narcotic Antagonists
  • naldemedine
  • Naltrexone
  • Oxycodone