Severe opioid withdrawal precipitated by Vivitrol®

R. S. Wightman, L. S. Nelson, Joshua Lee, L. M. Fox, S. W. Smith

Research output: Contribution to journalArticle

Abstract

The risk of severe precipitated opioid withdrawal (POW) is amplified when precipitated by a long-acting opioid antagonist. IM extended release naltrexone (XRNTX;Vivitrol®) is an FDA approved therapy to prevent relapse of opioid and alcohol abuse. Two cases of precipitated opioid withdrawal from XRNTX are presented that illustrate different patient reactions to POW. A 56-year-old woman developed a hypertensive emergency and required continuous intravenous vasodilator, clonidine, and intensive care monitoring after re-initiation of XRNTX following opioid relapse. A 25-year-old man developed agitation and altered mental status after receipt of XRNTX at the conclusion of a twelve-day detoxification program during which he continued surreptitious use of heroin. The patient received benzodiazepines and haloperidol without adequate affect, and required intubation with propofol, lorazepam, and dexmedetomidine infusions. Management of POW from XRNTX is a challenge to emergency providers and protocols to guide management do not exist. Recommended therapies include intravenous fluids, anti-emetics, clonidine, or benzodiazepines as well as therapy tailored to the organ system affected. To minimize risk of POW it is important for providers instituting XRNTX to adhere to the manufacturers warnings and clinic protocols including a naloxone challenge and ensure an adequate opioid free period prior to administration of XRNTX.

Original languageEnglish (US)
Pages (from-to)1128.e1-1128.e2
JournalAmerican Journal of Emergency Medicine
Volume36
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Opioid Analgesics
Clonidine
Benzodiazepines
Emergencies
Dexmedetomidine
Lorazepam
Recurrence
Naltrexone
Antiemetics
Narcotic Antagonists
Heroin
Propofol
Haloperidol
Critical Care
Naloxone
Vasodilator Agents
Intubation
Alcoholism
Therapeutics

Keywords

  • Addiction medicine
  • Medication safety
  • Naltrexone
  • Opioid withdrawal
  • Toxicology

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Wightman, R. S., Nelson, L. S., Lee, J., Fox, L. M., & Smith, S. W. (2018). Severe opioid withdrawal precipitated by Vivitrol®. American Journal of Emergency Medicine, 36(6), 1128.e1-1128.e2. https://doi.org/10.1016/j.ajem.2018.03.052

Severe opioid withdrawal precipitated by Vivitrol®. / Wightman, R. S.; Nelson, L. S.; Lee, Joshua; Fox, L. M.; Smith, S. W.

In: American Journal of Emergency Medicine, Vol. 36, No. 6, 01.06.2018, p. 1128.e1-1128.e2.

Research output: Contribution to journalArticle

Wightman, RS, Nelson, LS, Lee, J, Fox, LM & Smith, SW 2018, 'Severe opioid withdrawal precipitated by Vivitrol®', American Journal of Emergency Medicine, vol. 36, no. 6, pp. 1128.e1-1128.e2. https://doi.org/10.1016/j.ajem.2018.03.052
Wightman, R. S. ; Nelson, L. S. ; Lee, Joshua ; Fox, L. M. ; Smith, S. W. / Severe opioid withdrawal precipitated by Vivitrol®. In: American Journal of Emergency Medicine. 2018 ; Vol. 36, No. 6. pp. 1128.e1-1128.e2.
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