Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-25T05:58:42.080Z Has data issue: false hasContentIssue false
  • English
  • Français

Naldemedine-induced opioid withdrawal syndrome with severe psychiatric symptoms in an advanced cervical cancer patient without brain metastasis

Published online by Cambridge University Press:  27 December 2021

Mayumi Ishida Open the ORCID record for Mayumi Ishida [Opens in a new window] ,
Mie Hiraoka ,
Ayako Yaguchi ,
Koji Sugano ,
Nasako Adachi ,
Tomoko Itoga ,
Tomohito Ishiguro  and
Hideki Onishi Open the ORCID record for Hideki Onishi [Opens in a new window]
Mayumi Ishida*
Affiliation:
Departments of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
Mie Hiraoka
Affiliation:
Department of Nursing, Koshigaya Municipal Hospital, Saitama, Japan
Ayako Yaguchi
Affiliation:
Department of Pharmacy, Koshigaya Municipal Hospital, Saitama, Japan
Koji Sugano
Affiliation:
Division of Respiratory Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
Nasako Adachi
Affiliation:
Department of Nursing, Koshigaya Municipal Hospital, Saitama, Japan
Tomoko Itoga
Affiliation:
Department of Obstetrics and Gynecology, Koshigaya Municipal Hospital, Saitama, Japan
Tomohito Ishiguro
Affiliation:
Department of Obstetrics and Gynecology, Koshigaya Municipal Hospital, Saitama, Japan
Hideki Onishi
Affiliation:
Departments of Psycho-oncology, Saitama Medical University International Medical Center, Saitama, Japan
*
Author for correspondence: Mayumi Ishida, Department of Psycho-oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama350-1298, Japan. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Naldemedine, an oral peripheral μ-opioid receptor antagonist, was developed for the treatment of constipation, a side effect of opioid use. Naldemedine is not generally recognized as causing opioid withdrawal in which associated symptoms affecting the central nervous system.

Method

From the series of cancer patients undergoing symptom management, we report a case treated with naldemedine for constipation in relation to the use of opioids for cancer pain and who displayed severe psychological symptoms associated with withdrawal immediately after the use of naldemedine.

Results

The patient was a 36-year-old woman diagnosed with cervical cancer Stage IIB, PS3. When the patient, who was using oxycodone hydrochloride hydrate (80 mg/day) for ileal pain, was started on naldemedine for constipation, she complained of sweating after just 5 min and hallucinations after 1 h. The patient also displayed physical/behavioral abnormalities such as diarrhea and hyperactivity, and psychological abnormalities such as aggression toward staff.

Despite the psychiatric symptoms worsening over time, there were no abnormalities in terms of blood biochemical data, and no brain metastasis was observed on MRI. Based on the Clinical Opiate Withdrawal Scale, these symptoms were judged to indicate opioid withdrawal. Naldemedine was discontinued due to naldemedine-related opioid withdrawal syndrome and, thereafter, the psychiatric symptoms diminished, with no recurrence of similar symptoms observed to date.

Significance of results

If mental and behavioral abnormalities occur in patients receiving naldemedine, it is necessary to consider the possibility of opioid withdrawal syndrome as a differential diagnosis.

Keywords

CancerCase reportDeliriumNaldemedineOpioid withdrawal syndrome
Type
Case Report
Information
Palliative & Supportive Care , Volume 20 , Issue 3 , June 2022 , pp. 445 - 447
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Publishing.Google Scholar
Coluzzi, F, Scerpa, MS and Pergolizzi, J (2020) Naldemedine: A new option for OIBD. Journal of Pain Research 13, 1209–1222.CrossRefGoogle ScholarPubMed
Ishii, K, Yamashita, H, Yamaguchi, M, et al. (2020) Naldemedine-induced opioid withdrawal syndrome in a patient with breast cancer without brain metastasis. Internal Medicine 59(2), 293–296.CrossRefGoogle Scholar
Katakami, N, Harada, T, Murata, T, et al. (2017) Randomized phase III and extension studies of naldemedine in patients with opioid-induced constipation and cancer. Journal of Clinical Oncology 35(34), 3859–3866.CrossRefGoogle ScholarPubMed
Mesía, R, Virizuela Echaburu, JA, Gómez, J, et al. (2019) Opioid-induced constipation in oncological patients: New strategies of management. Current Treatment Options in Oncology 20(12), 91.CrossRefGoogle ScholarPubMed
Osaka, I, Ishiki, H, Yokota, T, et al. (2019) Safety and efficacy of naldemedine in cancer patients with opioid-induced constipation: A pooled, subgroup analysis of two randomised controlled studies. ESMO Open 4(4), e000527.CrossRefGoogle ScholarPubMed
Watari, R, Matsuda, A, Ohnishi, S, et al. (2019) Minimal contribution of P-gp on the low brain distribution of naldemedine, a peripherally acting μ-opioid receptor antagonist. Drug Metabolism and Pharmacokinetics 34(2), 126–133.CrossRefGoogle ScholarPubMed
Webster, LR, Nalamachu, S, Morlion, B, et al. (2018) Long-term use of naldemedine in the treatment of opioid-induced constipation in patients with chronic noncancer pain: A randomized, double-blind, placebo-controlled phase 3 study. Pain 159(5), 987–994.CrossRefGoogle ScholarPubMed
Wesson, DR and Ling, W (2003) The clinical opiate withdrawal scale (COWS). Journal of Psychoactive Drugs 35(2), 253–259.CrossRefGoogle Scholar