Delayed Norfentanyl Clearance During Pregnancy

BACKGROUND:We report a case of delayed norfentanyl clearance in a 33-year-old pregnant woman. Norfentanyl is the major metabolite of fentanyl. CASE:A multigravid woman with opioid use disorder presented at 7 weeks of gestation for treatment. Despite opioid abstinence, her urine was positive for norf...

Full description

Saved in:
Bibliographic Details
Published inObstetrics and gynecology (New York. 1953) Vol. 136; no. 5; pp. 905 - 907
Main Authors Wanar, Amita, Saia, Kelley, Field, Thomas A
Format Journal Article
LanguageEnglish
Published United States by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved 01.11.2020
Subjects
Adult
Analgesics, Opioid - pharmacokinetics
Female
Fentanyl - analogs & derivatives
Fentanyl - pharmacokinetics
Fentanyl - urine
Humans
Metabolic Clearance Rate
Opioid-Related Disorders - urine
Pregnancy
Pregnancy Complications - urine
Online AccessGet full text

Cover

Abstract BACKGROUND:We report a case of delayed norfentanyl clearance in a 33-year-old pregnant woman. Norfentanyl is the major metabolite of fentanyl. CASE:A multigravid woman with opioid use disorder presented at 7 weeks of gestation for treatment. Despite opioid abstinence, her urine was positive for norfentanyl on 10 distinct gas chromatography–mass spectrometry urine screens. The results demonstrated a steady decrease of norfentanyl over the course of 70 days after her last fentanyl usage, far exceeding expected rates of fentanyl clearance. CONCLUSION:This case highlights the importance of acknowledging pregnancy, genetic, or medication-induced changes to fentanyl pharmacokinetics when interpreting urine tests, especially given the potential sequelae of a false-positive urine test result.
AbstractList BACKGROUND:We report a case of delayed norfentanyl clearance in a 33-year-old pregnant woman. Norfentanyl is the major metabolite of fentanyl. CASE:A multigravid woman with opioid use disorder presented at 7 weeks of gestation for treatment. Despite opioid abstinence, her urine was positive for norfentanyl on 10 distinct gas chromatography–mass spectrometry urine screens. The results demonstrated a steady decrease of norfentanyl over the course of 70 days after her last fentanyl usage, far exceeding expected rates of fentanyl clearance. CONCLUSION:This case highlights the importance of acknowledging pregnancy, genetic, or medication-induced changes to fentanyl pharmacokinetics when interpreting urine tests, especially given the potential sequelae of a false-positive urine test result.
We report a case of delayed norfentanyl clearance in a 33-year-old pregnant woman. Norfentanyl is the major metabolite of fentanyl. A multigravid woman with opioid use disorder presented at 7 weeks of gestation for treatment. Despite opioid abstinence, her urine was positive for norfentanyl on 10 distinct gas chromatography-mass spectrometry urine screens. The results demonstrated a steady decrease of norfentanyl over the course of 70 days after her last fentanyl usage, far exceeding expected rates of fentanyl clearance. This case highlights the importance of acknowledging pregnancy, genetic, or medication-induced changes to fentanyl pharmacokinetics when interpreting urine tests, especially given the potential sequelae of a false-positive urine test result.
BACKGROUND: We report a case of delayed norfentanyl clearance in a 33-year-old pregnant woman. Norfentanyl is the major metabolite of fentanyl. Case: A multigravid woman with opioid use disorder presented at 7 weeks of gestation for treatment. Despite opioid abstinence, her urine was positive for norfentanyl on 10 distinct gas chromatography–mass spectrometry urine screens. The results demonstrated a steady decrease of norfentanyl over the course of 70 days after her last fentanyl usage, far exceeding expected rates of fentanyl clearance. CONCLUSION: This case highlights the importance of acknowledging pregnancy, genetic, or medication-induced changes to fentanyl pharmacokinetics when interpreting urine tests, especially given the potential sequelae of a false-positive urine test result.
Author Wanar, Amita
Field, Thomas A
Saia, Kelley
AuthorAffiliation Departments of Obstetrics and Gynecology and Psychiatry, Boston University School of Medicine, and the Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
AuthorAffiliation_xml – name: Departments of Obstetrics and Gynecology and Psychiatry, Boston University School of Medicine, and the Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
Author_xml – sequence: 1
  givenname: Amita
  surname: Wanar
  fullname: Wanar, Amita
  organization: Departments of Obstetrics and Gynecology and Psychiatry, Boston University School of Medicine, and the Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts
– sequence: 2
  givenname: Kelley
  surname: Saia
  fullname: Saia, Kelley
– sequence: 3
  givenname: Thomas
  surname: Field
  middlename: A
  fullname: Field, Thomas A
BackLink https://www.ncbi.nlm.nih.gov/pubmed/33030873$$D View this record in MEDLINE/PubMed
BookMark eNp9j11LwzAUhoNM3If-A5H-gc5kp03Sy9G5KQznhYJ3JU1Ot2mWjnRj9N8bqYp44bk5nMPzvvAMSc_VDgm5ZnTMaCZup6vFmP6ahFF-RgZMCognAK89MqB0ksVCJkmfDJvmLUCMZ3BB-gAUaAAHZDxDq1o00WPtK3QH5Vob5RaVV05jNDv6rVtHTx7XLjzaS3JeKdvg1dcekZf53XN-Hy9Xi4d8uow1pJzHhlcGUKIpyxRKaTQPB2JmJBdMaV0ykaSohYCJZEJjBhxBKqMo52WiUxiRpOvVvm4aj1Wx99ud8m3BaPGpXwT94q9-iN10sf2x3KH5CX37BkB2wKm2B_TNuz2e0BcbVPaw-b_7A63XaEY
CitedBy_id crossref_primary_10_1007_s13669_023_00371_w
crossref_primary_10_1089_bfm_2023_29256_abm
crossref_primary_10_1007_s10995_023_03664_x
crossref_primary_10_1016_j_ajogmf_2021_100366
crossref_primary_10_1016_j_ajogmf_2023_101206
crossref_primary_10_1093_jalm_jfae036
crossref_primary_10_1016_j_xagr_2024_100313
crossref_primary_10_1097_ADM_0000000000001043
Cites_doi 10.1111/bcp.13129
10.1016/j.mayocp.2016.12.007
10.1038/clpt.1980.138
10.15585/mmwr.mm6614a2
10.1371/journal.pmed.1002160
10.1016/j.neuropharm.2017.10.016
10.1016/S0025-6196(11)60750-7
ContentType Journal Article
Copyright 2020 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
Copyright_xml – notice: 2020 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
DBID CGR
CUY
CVF
ECM
EIF
NPM
AAYXX
CITATION
DOI 10.1097/AOG.0000000000004106
DatabaseName Medline
MEDLINE
MEDLINE (Ovid)
MEDLINE
MEDLINE
PubMed
CrossRef
DatabaseTitle MEDLINE
Medline Complete
MEDLINE with Full Text
PubMed
MEDLINE (Ovid)
CrossRef
DatabaseTitleList
MEDLINE
CrossRef
Database_xml – sequence: 1
  dbid: NPM
  name: PubMed
  url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
  sourceTypes: Index Database
– sequence: 2
  dbid: EIF
  name: MEDLINE
  url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search
  sourceTypes: Index Database
DeliveryMethod fulltext_linktorsrc
Discipline Medicine
EISSN 1873-233X
EndPage 907
ExternalDocumentID 10_1097_AOG_0000000000004106
33030873
10.1097/AOG.0000000000004106
Genre Journal Article
Case Reports
GroupedDBID -
.XZ
.Z2
01R
08R
0R
123
1B1
1J1
1~5
29N
2CO
3O-
4.4
40H
4G.
4Q1
4Q2
4Q3
53G
55
5RE
5VS
7-5
77Y
7O
7O~
85S
AAAXR
AACTN
AAEDT
AAMOA
AAMTA
AAPBV
AAQFI
AAQQT
AARTV
AAWTL
AAXQO
ABBUW
ABFLS
ABMAC
ABPTK
ABXVJ
ABZAD
ACDDN
ACEWG
ACGFS
ACIUM
ACWDW
ACWRI
ACXNZ
ADBBV
ADFPA
ADNKB
AE3
AENEX
AFFNX
AFRUD
AFTJW
AFUWQ
AGNAY
AHULI
AHVBC
AIJEX
AJIOK
AJNYG
AJYGW
ALMA_UNASSIGNED_HOLDINGS
AMJPA
AQIPR
ASCII
AWKKM
BAWUL
BOYCO
BQLVK
BYPQX
C45
CS3
DU5
DUNZO
E.X
EBS
EJD
EX3
F2K
F2L
F2M
F2N
F5P
FDB
FEDTE
FGOYB
FL-
FW0
G8K
GJ
H0
H0~
HVGLF
HZ
IHE
IKYAY
IN
IN~
JF9
JG8
JK3
JK8
K
K8S
KD2
KMI
L-C
L7B
M41
N9A
NEJ
NQ-
N~7
N~B
N~M
O9-
OAG
OAH
OBH
OCUKA
ODA
OHASI
OHH
OHM
OHT
OL1
OLG
OLH
OLU
OLV
OLW
OLY
OLZ
OPUJH
ORVUJ
OUVQU
OVD
OVDNE
OVIDH
OVLEI
OVOZU
OWU
OWV
OWX
OWY
OWZ
OXXIT
P-K
P2P
R2-
R58
RIG
RLZ
ROL
RPZ
S-
S4R
S4S
SSZ
STF
TWZ
UHB
UNR
V2I
WH7
WOQ
WOW
X3V
X3W
X7M
XPP
XZ
YQJ
Z2
ZA5
ZGI
ZXP
---
--K
.3C
.55
.GJ
0R~
1CY
354
AAAAV
AAGIX
AAHPQ
AAIQE
AAJCS
AALRI
AAQKA
AAQXK
AASCR
AASOK
AASXQ
AAUEB
AAXUO
ABASU
ABDIG
ABJNI
ABVCZ
ACCJW
ACGFO
ACILI
ACLDA
ACOAL
ACXJB
ADGGA
ADHPY
ADMUD
AEBDS
AEETU
AFDTB
AFEXH
AFSOK
AGINI
AHOMT
AHQNM
AHRYX
AINUH
AJNWD
AJZMW
AKRWK
AKULP
ALMTX
AMKUR
AMNEI
AOHHW
BS7
CGR
CUY
CVF
DIWNM
ECM
EEVPB
EIF
ERAAH
FCALG
FD6
GNXGY
GQDEL
HLJTE
HZ~
IKREB
IPNFZ
K-A
K-F
M18
MZP
N4W
NPM
ODMTH
OHYEH
OJAPA
OLB
OWBYB
TEORI
TSPGW
VVN
W3M
XXN
XYM
ZB8
ZZMQN
~S-
AAYXX
CITATION
ID FETCH-LOGICAL-c3566-d6fd3e8edbb53b8dc6e8eee9d8671accb1745ec7732817ce936e38ada066b4c53
ISSN 0029-7844
IngestDate Fri Aug 23 02:59:00 EDT 2024
Wed Oct 16 00:45:45 EDT 2024
Fri Oct 23 16:05:55 EDT 2020
IsPeerReviewed true
IsScholarly true
Issue 5
Language English
LinkModel OpenURL
MergedId FETCHMERGED-LOGICAL-c3566-d6fd3e8edbb53b8dc6e8eee9d8671accb1745ec7732817ce936e38ada066b4c53
PMID 33030873
PageCount 3
ParticipantIDs crossref_primary_10_1097_AOG_0000000000004106
pubmed_primary_33030873
wolterskluwer_health_10_1097_AOG_0000000000004106
ProviderPackageCode OVOZU
L-C
C45
7O~
AARTV
ADFPA
OLH
ASCII
BYPQX
OLG
AAMOA
ODA
OHH
ABZAD
ABBUW
JK3
ADNKB
JK8
H0~
1J1
OLV
OLU
JG8
OLW
OLZ
OLY
F2K
F2M
F2L
F2N
OHASI
AHVBC
AJNYG
FL-
KMI
K8S
OVLEI
AJIOK
OPUJH
V2I
.XZ
S4R
S4S
4Q1
DUNZO
OAG
4Q2
OVDNE
4Q3
AMJPA
OAH
OVD
AHULI
ACEWG
.Z2
N~7
IKYAY
OVIDH
AWKKM
40H
N~B
OBH
OUVQU
ORVUJ
X3V
X3W
ACDDN
ACWRI
BOYCO
AIJEX
AAXQO
AAMTA
AAAXR
OWU
E.X
OCUKA
OWV
OWY
01R
ACXNZ
OWX
OWZ
OL1
ABXVJ
IN~
KD2
OXXIT
77Y
ACWDW
JF9
FW0
PublicationCentury 2000
PublicationDate 2020-November
2020-11-00
PublicationDateYYYYMMDD 2020-11-01
PublicationDate_xml – month: 11
  year: 2020
  text: 2020-November
PublicationDecade 2020
PublicationPlace United States
PublicationPlace_xml – name: United States
PublicationTitle Obstetrics and gynecology (New York. 1953)
PublicationTitleAlternate Obstet Gynecol
PublicationYear 2020
Publisher by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved
Publisher_xml – name: by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved
References Moeller (R1-20230711) 2017; 92
Kuip (R4-20230711) 2016; 83
Smith (R2-20230711) 2009; 84
Armenian (R6-20230711) 2018; 134
Somerville (R3-20230711) 2017; 66
Labroo (R8-20230711) 1997; 25
McClain (R7-20230711) 1980; 28
Pariente (R5-20230711) 2016; 13
References_xml – volume: 83
  start-page: 294
  year: 2016
  ident: R4-20230711
  article-title: A review of factors explaining variability in fentanyl pharmacokinetics; focus on implications for cancer patients
  publication-title: Br J Clin Pharmacol
  doi: 10.1111/bcp.13129
  contributor:
    fullname: Kuip
– volume: 92
  start-page: 774
  year: 2017
  ident: R1-20230711
  article-title: Clinical interpretation of urine drug tests
  publication-title: Mayo Clinic Proc
  doi: 10.1016/j.mayocp.2016.12.007
  contributor:
    fullname: Moeller
– volume: 28
  start-page: 106
  year: 1980
  ident: R7-20230711
  article-title: Intravenous fentanyl kinetics
  publication-title: Clin Pharmacol Ther
  doi: 10.1038/clpt.1980.138
  contributor:
    fullname: McClain
– volume: 66
  start-page: 382
  year: 2017
  ident: R3-20230711
  article-title: Characteristics of fentanyl overdose—Massachusetts, 2014–2016
  publication-title: MMWR Morb Mortal Wkly Rep
  doi: 10.15585/mmwr.mm6614a2
  contributor:
    fullname: Somerville
– volume: 25
  start-page: 1072
  year: 1997
  ident: R8-20230711
  article-title: Fentanyl metabolism by human hepatic and intestinal cytochrome P450 3A4: implications for inter-individual variability in disposition, efficacy, and drug interactions
  publication-title: Drug Metab Disposition
  contributor:
    fullname: Labroo
– volume: 13
  start-page: e1002160
  year: 2016
  ident: R5-20230711
  article-title: Pregnancy-associated changes in pharmacokinetics: a systematic review
  publication-title: PLoS Med
  doi: 10.1371/journal.pmed.1002160
  contributor:
    fullname: Pariente
– volume: 134
  start-page: 121
  year: 2018
  ident: R6-20230711
  article-title: Fentanyl, fentanyl analogs and novel synthetic opioids: a comprehensive review
  publication-title: Neuropharmacology
  doi: 10.1016/j.neuropharm.2017.10.016
  contributor:
    fullname: Armenian
– volume: 84
  start-page: 613
  year: 2009
  ident: R2-20230711
  article-title: Opioid metabolism
  publication-title: Mayo Clinic Proc
  doi: 10.1016/S0025-6196(11)60750-7
  contributor:
    fullname: Smith
SSID ssj0001693
Score 2.4333756
Snippet BACKGROUND:We report a case of delayed norfentanyl clearance in a 33-year-old pregnant woman. Norfentanyl is the major metabolite of fentanyl. CASE:A...
We report a case of delayed norfentanyl clearance in a 33-year-old pregnant woman. Norfentanyl is the major metabolite of fentanyl. A multigravid woman with...
BACKGROUND: We report a case of delayed norfentanyl clearance in a 33-year-old pregnant woman. Norfentanyl is the major metabolite of fentanyl. Case: A...
SourceID crossref
pubmed
wolterskluwer
SourceType Aggregation Database
Index Database
Publisher
StartPage 905
SubjectTerms Adult
Analgesics, Opioid - pharmacokinetics
Female
Fentanyl - analogs & derivatives
Fentanyl - pharmacokinetics
Fentanyl - urine
Humans
Metabolic Clearance Rate
Opioid-Related Disorders - urine
Pregnancy
Pregnancy Complications - urine
Title Delayed Norfentanyl Clearance During Pregnancy
URI https://www.ncbi.nlm.nih.gov/pubmed/33030873
Volume 136
hasFullText 1
inHoldings 1
isFullTextHit
isPrint
link http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV3da9swEBdZCmNQxr6bfeGHvQV7sWV9-DG0a8tC27GlpG_BkuUy1jkjTRnZf7n_aCefrNhdKVvzYGITC-XuLN-dfvc7Qt5pTgueGHiQaDkKUyNNmHGRhwlXgrO0TASz1chHx_zwNP14xs56vd8t1NLVSkX61411JXfRKlwDvdoq2f_QrB8ULsB30C8cQcNw_Ccd75mLfA0e4_FiWVoMeLW-GO7aPhB1HcAeViB-Wppzy6rR2b89UaBdS86PFM3n68poZGNqdeeJhnb3q5UrmOUV4rHH37-u_Hr-JUfA7cTuAfgM_X7T-xohSC5n6vILEEzGnfwCOMHTTY1L1c5n-KmCIeNsD5rZgoleRh7ZX7vSs4Xd_r8cOvg_Vlk1C-HQdiqt0xF2s8TmozulXRajIyQSRUYGV2opaJjQupnwZilHMhVns6y1MGcj1nrHZ9hp96_XB9ISj08OkNbSfdJ4dI2t24VPt91wj2wlImOsT7bGk8-ziXcPLPtNgzuy_6mp58zE-5vG6fhL3kna_onS_FYLs-URTR-Rhy6UCcZol49Jz1RPyP0jB9Z4SiJnnkHLPANvngGaZ-DN8xk53f8w3T0MXXuOUFMIAsKClwWFh7tQilElC83hxJissJSJudYKgl1mtLB0ULHQJqPcUJkXOXi5KtWMPif9alGZHRLItIjzrDS85BxCcC2ZpErFWSx5LmkhBiRshDD_gSws8wY9AUKbXxfagLxASflfU1pzX9IBiTuim2O58a2jvbzDPa_Ig83D9Jr0V8sr8wbc15V66wziDxEPkVg
link.rule.ids 315,786,790,27955,27956
linkProvider Library Specific Holdings
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Delayed+Norfentanyl+Clearance+During+Pregnancy&rft.jtitle=Obstetrics+and+gynecology+%28New+York.+1953%29&rft.au=Wanar%2C+Amita&rft.au=Saia%2C+Kelley&rft.au=Field%2C+Thomas+A&rft.date=2020-11-01&rft.pub=by+The+American+College+of+Obstetricians+and+Gynecologists.+Published+by+Wolters+Kluwer+Health%2C+Inc.+All+rights+reserved&rft.issn=0029-7844&rft.eissn=1873-233X&rft.volume=136&rft.issue=5&rft.spage=905&rft.epage=907&rft_id=info:doi/10.1097%2FAOG.0000000000004106&rft.externalDocID=10.1097%2FAOG.0000000000004106
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0029-7844&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0029-7844&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0029-7844&client=summon