Severe opioid withdrawal syndrome after a single dose of nalmefene
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We would like to present two case reports of severe opioid withdrawal due to drug-drug interaction between the recently approved opioid antagonist nalmefene and opioid in a context of addiction of codeine, respectively methadone.
A 43-year-old man was brought by ambulance to the emergency department (ED) with severe agitation and clinical signs of severe opioid withdrawal approximately 2 h after a single dose of nalmefene (Selincro®, Lundbeck (Switzerland)) for his alcohol dependence. His medical history included paranoid schizophrenia, depression, and alcohol and codeine dependence. He consumed up to two bottles of Makatussin® Hustentropfen (Gebropharma AG, Liestal, Switzerland), a codeine-containing cough medicine, per day (equivalent to 636 mg codeine base per day). The psychiatrist who prescribed the nalmefene was unaware of the extent of the patient’s codeine abuse.
The patient needed high bolus doses of midazolam (cumulative dose 25 mg, commenced in the...
KeywordsClonidine Opioid Antagonist Opioid Withdrawal Nalmefene Opioid Abuse
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