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

• Published in: Internal Medicine Vol. 59; no. 2; pp. 293 - 296
• Main Authors: Ishii, Koji, Yamashita, Haruna, Yamaguchi, Midori, Komatsu, Yuya, Ryu, Emi, Morishita, Satoru, Matsuo, Kumi, Kamada, Masatsugu, Ikeda, Tsunako, Ashizawa, Kazuto, Hara, Tetsuya
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15.01.2020; Japan Science and Technology Agency
• Subjects: Analgesics, Opioid - therapeutic use; Bone cancer; Breast cancer; Breast Neoplasms - pathology; Cancer Pain - drug therapy; Case Report; Constipation; Female; Fentanyl; Humans; Internal medicine; Intravenous administration; Metastases; Metastasis; Middle Aged; naldemedine; Naltrexone - adverse effects; Naltrexone - analogs & derivatives; Naltrexone - therapeutic use; Narcotic Antagonists - adverse effects; Narcotic Antagonists - therapeutic use; Narcotics; Opioid receptors (type mu); opioid withdrawal syndrome (OWS); Opioid-Induced Constipation - drug therapy; opioid-induced-constipation (OIC); Oxycodone; Oxycodone - adverse effects; Oxycodone - therapeutic use; Substance Withdrawal Syndrome - drug therapy; Substance Withdrawal Syndrome - etiology; opioid withdrawal syndrome (OWS); opioid-induced-constipation (OIC); naldemedine
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.3098-19

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.