Skip to main content Accessibility help
×
Home
Hostname: page-component-55597f9d44-dfw9g Total loading time: 0.288 Render date: 2022-08-11T21:03:35.748Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true } hasContentIssue true

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*
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: mayumi_i@saitama-med.ac.jp

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.

Type
Case Report
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, 12091222.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), 293296.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), 38593866.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), 126133.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), 987994.CrossRefGoogle ScholarPubMed
Wesson, DR and Ling, W (2003) The clinical opiate withdrawal scale (COWS). Journal of Psychoactive Drugs 35(2), 253259.CrossRefGoogle Scholar

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

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

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

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

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

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

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *