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Opioid withdrawal syndrome developing after long-term administration of naldemedine

Published online by Cambridge University Press:  11 May 2022

Mayumi Ishida
Affiliation:
Departments of Psycho-Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
Nozomu Uchida
Affiliation:
Department of General Medicine, Ogano Town Central Hospital, Hidaka, Saitama, Japan
Akira Yabuno
Affiliation:
Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
Kosei Hasegawa
Affiliation:
Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
Naoki Mizunuma
Affiliation:
Departments of Psycho-Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan Tokyo Kagurazaka Law Firm, Tokyo, Japan
Takao Takahashi
Affiliation:
Departments of Supportive Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
Hideki Onishi*
Affiliation:
Departments of Psycho-Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
*
Author for correspondence: Hideki Onishi, Department of Psycho-Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka City, Saitama 350-1298, Japan. E-mail: honishi@saitama-med.ac.jp

Abstract

Objective

One of the side effects of opioid administration is opioid-induced constipation (OIC). To address this side effect, the oral peripheral μ opioid receptor antagonist naldemedine was developed. As this drug does not cross the blood–brain barrier, it is thought that it does not lead to opioid withdrawal syndrome (OWS) with central nervous system symptoms.

Methods

Here, we report a cancer patient who presented with symptoms centered round anxiety and irritation 4 months after administration of naldemedine for OIC and who was diagnosed with OWS after close investigation.

Results

The patient was a 65-year-old female who had surgery for stage IB endometrial cancer 4 years previously, but experienced recurrence involving the pelvis 2 years later. Medical narcotics were used to control pain, but naldemedine was started to control subsequent constipation. When naldemedine-related OWS was suspected and the administration of naldemedine discontinued, the above symptoms disappeared within two days, and no recurrence was observed thereafter.

Significance of the results

For patients receiving naldemedine, it is necessary to consider the possibility of OWS regardless of the period of administration in order to maintain patient quality of life.

Type
Case Report
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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References

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