Cilnidipine/fentanyl interaction
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Respiratory depression following transdermal fentanyl administration: case report A 60-year-old man developed respiratory depression following concomitant therapy with fentanyl [Durotep MT Patch] transdermal patches for pain and numbness in his back and legs secondary to lumbar canal stenosis alongside cilnidipine for hypertension. The man received fentanyl transdermal patches initially at 2.1mg every 3 days but increased to 4.2mg every 3 days due to inadequate pain relief. In addition, he had a history of hypertension and had received oral cilnidipine 20mg [frequency not stated] for the past 2 years. He experienced difficulty in breathing and respiratory depression when warming his upper body 3 months after starting fentanyl therapy. He was diagnosed with fentanyl-associated respiratory depression possibly caused by exposing the patch to heat leading to increased fentanyl blood levels. Fentanyl was discontinued and replaced by morphine. The man’s respiratory depression improved but did not fully resolve and myocardial ischaemia was suspected. He was subsequently diagnosed with stenosis of the distal left coronary artery and underwent percutaneous coronary intervention which resulted in further improvement in respiratory symptoms. Author comment: "[W]e believed that increased blood fentanyl levels were the cause of his respiratory depression". "[I]t is possible that the calcium blocker might have led to the increased fentanyl blood concentration and respiratory depression". Matsuki Y, et al. Suspected respiratory depression associated with use of a transdermal fentanyl patch. Pain Physician 15: E536-E537, No. 4, Jul-Aug 2012 803077439 Japan
0114-9954/10/1421-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 29 Sep 2012 No. 1421
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