One Case of Acute Withdrawal Syndrome Caused by Naloxone

doi:10.19803/j.1672-8629.20240817

Abstract

Abstract: Objective To investigate the clinical manifestations and mechanisms of naloxone-induced acute withdrawal syndrome during the treatment of acute opioid overdose. Methods The clinical data of a non-small cell lung cancer patient was analyzed, who had experienced acute withdrawal syndrome after receiving a standard naloxone dose for morphine slow-release tablet overdose. Related literature on clinical symptoms, mechanisms, and treatment strategies was reviewed. Results The patient was treated symptomatically for acute withdrawal syndrome and gradually stabilized after adjustment of the naloxone dose and administration method. Conclusion Opioid overdose management requires a personalized approach to naloxone dosing and administration, and the risk of acute withdrawal syndrome should be taken into consideration to ensure the safety of patients.

Key words: Naloxone, Morphine Sustained-Release Tablets, Morphine Poisoning, Acute Withdrawal Syndrome, Adverse Drug Reaction

CLC Number:

CHEN Huabao, LIU Wei, JIANG Ting, ZHENG Lingli, LI Jing. One Case of Acute Withdrawal Syndrome Caused by Naloxone[J]. Chinese Journal of Pharmacovigilance, 2025, 22(8): 944-946.

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https://zgywjj.magtechjournal.com/EN/Y2025/V22/I8/944

References

[1] THER P.Pharmacological Data Science Perspective on Fatal Incidents of Morphine Treatment[J]. Pharmacology and Therapeutics, 2023, 241(1): 1-5.
[2] ZHUANG Y.Molecular Recognition of Morphine and Fentanyl by the Human Mu-Opioid Receptor[J]. Cell, 2022, 185(23): 4361-4375.
[3] FALLON M. An International, Open-Label, Randomised Trial Comparing a Two-Step Approach Versus the Standard Three-Step Approach of the WHO Analgesic Ladder in Patients with Cancer[J]. Annals of Oncology: Official Journal of the European Society for Medical Oncology, 2022, 33(12): 1296-1303.
[4] GARGK K.Morphine Sustained Release Tablets Becoming Ghost Pill: a Palliative Conundrum[J]. Indian Journal of Palliative Care, 2022, 28(2): 224-225.
[5] SHARMA DC.Morphine Manifesto Seeks to Boost Access to Oral Morphine[J]. Lancet Oncology, 2023, 25(1): 1-5.
[6] STANTON AP.Correlation between Oral Morphine Requirements and Discharge Prescriptions Provided[J]. Journal of the American Academy of Physician Assistants, 2023, 36(12): 1.
[7] TORRES-LOCKHART KE.Clinical Management of Opioid With-drawal[J]. Addiction, 2022, 117(9): 2540-2550.
[8] DUNN KE.Operational Definition of Precipitated Opioid Withdrawal[J]. Front Psychiatry, 2023, 14: 1141980.
[9] CHHABRA N.Treatment of Acute Naloxone-Precipitated Opioid Withdrawal with Buprenorphine[J]. The American Journal of Emergency Medicine, 2020, 38(3): 1-3.
[10] SUN HL.Naloxone-Precipitated Acute Opioid Withdrawal Syndrome after Epidural Morphine[J]. AnesthAnalg, 1998, 86(3): 544-545.
[11] LEWTERL A.Slow-Sustained Delivery of Naloxone Reduces Typical Naloxone-Induced Precipitated Opioid Withdrawal Effects in Male Morphine-Dependent Mice[J]. Journal of Neuroscience Research, 2022, 100(1): 339-352.
[12] OLMO M.Acute Opioid Withdrawal Syndrome from Naloxone/Naloxegol Interaction[J]. BMJ Support Palliat Care, 2021, 11(4): 408-410.
[13] KUNZLER NM.Opioid Withdrawal Precipitated by Long-Acting Antagonists[J]. The Journal of Emergency Medicine, 2020, 58(2): 245-253.
[14] NARANJO CA.A Method for Estimating the Probability of Adverse Drug Reactions[J]. Clinical Pharmacology and Therapeutics, 1981, 30(2): 239-245.
[15] ABDELAL R.The Need for Multiple Naloxone Administrations for Opioid Overdose Reversals: a Review of the Literature[J]. Substance Abuse, 2022, 43(1): 774-784.
[16] DAHAN A.Fact vs Fiction: Naloxone in the Treatment of Opioid-Induced Respiratory Depression in the Current Era of Synthetic Opioids[J]. Front Public Health, 2024, 12: 1346109.
[17] LEMEN PM.High-Dose Naloxone Formulations are not as Essential as We Thought[J]. Harm Reduction Journal, 2024, 21(1): 93.
[18] SAARI TI.Clinical Pharmacokinetics and Pharmacodynamics of Naloxone[J]. Clinical Pharmacokinetics, 2024, 63(4): 397-422.
[19] FOLDES FF.The Human Pharmacology and Clinical Use of Narcotic[J]. Medical Clinics of North America, 1964, 48: 421-443.
[20] BUAJORDET I.Adverse Events after Naloxone Treatment of Episodes of Suspected Acute Opioid Overdose[J]. European Journal of Emergency Medicine, 2004, 11(1): 19-23.
[21] ISOARDI KZ.Acute Opioid Withdrawal Following Intramuscular Administration of Naloxone 1.6 mg: a Prospective Out-of-Hospital Series[J]. Annals of Emergency Medicine, 2022, 80(2): 120-126.
[22] Medicines Associated with Dependence or Withdrawal Symptoms Safe Prescribing and Withdrawal Management for Adults[M]. London: National Institute for Health and Care Excellence (NICE), 2022: 4-38.
[23] MOSHIRI M.Buprenorphine Induced Opioid Withdrawal Syndrome Relieved by Adjunctive Magnesium a Clinical Trial[J]. Journal of Substance Use and Addiction Treatment, 2024, 160(1): 209307.
[24] JUDITH EO, JOHN M, DONALD Y, et al.Tintinalli's Emergency Medicine: a Comprehensive Study Guide[M]. 7th ed. New York: McGraw Hill Medical, 2019.
[25] MARX JA, HOCKBERGER RS, WALLS RM, et al.Rosen's Emergency Medicine: Concepts and Clinical Practice[M]. 8th ed. Philadelphia: Saunders, 2013.
[26] BOLAND J.Importance of the Correct Diagnosis of Opioid-Induced Respiratory Depression in Adult Cancer Patients and Titration oF Naloxone[J]. Clinical Practice, 2013, 13(2): 149-151.
[27] QUATTLEBAUM THN.A Case of Buprenorphine-Precipitated Withdrawal Managed with High-Dose Buprenorphine[J]. Family Practice, 2022, 39(2): 292-294.