Fentanyl overdose
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Drug toxicity leading to coma following transdermal administration: case report A 60-year-old woman was prescribed a fentanyl 12.5 µg/h patch for arthritis pain, but inadvertently received a fentanyl 75 µg/h patch from her pharmacist. She developed fatigue, lethargy and concentration deficits 1 day after first application of the patch, and contracted a radius fracture during a fall on her way to the bathroom during the second night. No surgery was performed and she was discharged home despite intense pain. On consultation, her general practitioner recommended using a second fentanyl patch as treatment for ’almost unbearable’ pain. She became lethargic and comatose during the subsequent hours, her respiratory rate decreased and her pupils dilated. She was hospitalised and survived [treatment not stated]. Author comment: It is possible that our patient also experienced the phenomenon of hyperalgesia, which can occur after overdose of an opioid during an episode of acute pain; the elicited neuropathological mechanisms reverse the analgesic effect of the opioid. This explains the severe pain after the application of the too highly dosed fentanyl patch. Brune K, et al. [Transdermal fentanyl: what if doctor and pharmacist fail?]. MMW Fortschritte der Medizin 152: 41, No. 15, 15 Apr 2010 [German] 803027840 Germany
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Reactions 24 Jul 2010 No. 1311
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