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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 Open the ORCID record for Mayumi Ishida [Opens in a new window] ,
Mie Hiraoka ,
Ayako Yaguchi ,
Koji Sugano ,
Nasako Adachi ,
Tomoko Itoga ,
Tomohito Ishiguro  and
Hideki Onishi Open the ORCID record for Hideki Onishi [Opens in a new window]
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
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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.

Keywords

CancerCase reportDeliriumNaldemedineOpioid withdrawal syndrome
Type
Case Report
Information
Palliative & Supportive Care , Volume 20 , Issue 3 , June 2022 , pp. 445 - 447
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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