Opioid substitution therapy or hidden opioids are a minefield for nalmefene: an atypical case series of 11 patients in Lorraine

Opioid antagonists such as naltrexone and nalmefene are used in drug therapy for alcoholism. Nalmefene, approved in Europe in February 2013 for the reduction of alcohol consumption, is used in patients with alcohol dependence. We report 11 cases of opioid withdrawal syndrome after a single dose of n...

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Bibliographic Details
Published in:Fundamental & clinical pharmacology 2017-10, Vol.31 (5), p.574-579
Main Authors: Yéléhé‐Okouma, Melissa, Martini, Hervé, Lemarié, Jérémie, Labroca, Pierre, Petitpain, Nadine, Gibaja, Valérie, Paille, François, Gillet, Pierre
Format: Article
Language:English
Subjects:
Adult
Aged
Alcohol
Alcoholism
Alcoholism - diagnosis
Alcoholism - drug therapy
Alcohols
Analgesics, Opioid - adverse effects
Antagonists
Buprenorphine
Drug abuse
Drug dependence
Female
Fentanyl
France - epidemiology
Gastrointestinal Diseases - chemically induced
Health care
Heroin
Humans
Life Sciences
Male
Medical personnel
Methadone
Middle Aged
nalmefene
Naltrexone
Naltrexone - analogs & derivatives
Naltrexone - therapeutic use
Narcotic Antagonists - therapeutic use
Narcotics
Opiate Substitution Treatment - methods
Opioid receptors
opioid substitution therapy
opioid withdrawal syndrome
Pancreatitis - chemically induced
Patients
Pharmacology
Receptors
Retrospective Studies
Substance Withdrawal Syndrome - diagnosis
Substance Withdrawal Syndrome - drug therapy
Therapy
Toxicology
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Summary:Opioid antagonists such as naltrexone and nalmefene are used in drug therapy for alcoholism. Nalmefene, approved in Europe in February 2013 for the reduction of alcohol consumption, is used in patients with alcohol dependence. We report 11 cases of opioid withdrawal syndrome after a single dose of nalmefene in patients usually treated with methadone, buprenorphine, but also with fentanyl or loperamide. Nalmefene is both a partial agonist and an antagonist of opioid receptors. Regarding to its opioid antagonist activity, nalmefene is contraindicated in patients with an opioid treatment. Therefore, when prescribing or delivering nalmefene, healthcare professionals need to be vigilant about any type of opioid exposure, even masked or hidden, to avoid these potential life‐threatening syndromes.
ISSN:0767-3981
1472-8206
DOI:10.1111/fcp.12286