Buprenorphine
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Various toxicities following off-label treatment: 2 case reports In a case series of six patients who received off-label buprenorphine from 2013 to 2016, two men aged 49 years and 43 years were described who developed nausea, urinary retention, dysphoria, tachycardia, confusion, non-command auditory hallucinations or insomnia following off-label treatment with buprenorphine for suicidal ideation [routes not stated; times to reactions onsets not clearly stated; not all outcomes stated]. Case 2 from the article (a 49-year-old man): The man presented to the outpatient clinic with refractory major depressive disorder, opioid use disorder, suicidal ideation and significant chronic back pain associated with degenerative disc disease. Anamnesis revealed that four years prior, he had started receiving oxycodone for major depressive disorder and had quickly escalated its dose. Two years later, he had recognised his opioid use as a problem and sought unspecified inpatient treatment which had failed. Thereafter, he had been treated with buprenorphine which was later discontinued due to increase in his opioid craving. Over the next two years, he had undergone unsuccessful trials of various unspecified treatments. He had been treated with ketamine leading to a limited improvement of depressive symptoms. Thereafter, he exhibited worsening hopelessness, suicidal thoughts and persistent pain. He had been tried with celecoxib, however his symptoms failed to improve. Upon current presentation, he started receiving off-label treatment with buprenorphine 8 mg/day for suicidal ideation. A month later, he reported various side-effects of buprenorphine characterised by nausea, dysphoria and urinary retention. His pain, depression and suicidal ideation had not been controlled by buprenorphine therapy. He tapered-down the dose of buprenorphine to 0.5 mg/daily. However, he was still not able to tolerate buprenorphine therapy. Upon follow-up, prescription review revealed that he had been receiving several unspecified opioid prescriptions from different providers. He appeared defensive about his continued opioid use and refused a urine drug screen test. Thereafter, he became lost to follow-up. Case 4 from the article (a 43-year-old man): The man was hospitalised following a suicide attempt by ingestion of unspecified hand sanitiser with a positive urine drug screen for opioids [specific opioid not stated]. He reported overwhelming hopelessness because of chronic knee pain with resultant disability and unemployment. He had been receiving high doses of oxycodone and hydrocodone prior to the suicide attempt. He was diagnosed with major depressive disorder, borderline personality disorder and opioid use disorder. He was initiated on gabapentin and meloxicam for the knee pain. He was also treated with electric convulsive therapy (ECT) with mild headache as his only initial side effect. After five days of hospital stay, he reported return of suicidal ideation due to his knee pain. His therapy with hydrocodone and oxycodone were discontinued. H
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