Oxycodone withdrawal
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Cardiomyopathy: case report A 61-year-old woman, who had multijoint degenerative osteoarthritis, developed cardiomyopathy following oxycodone withdrawal. The woman, who had received oxycodone 40mg [OxyContin] twice daily and hydromorphone for several months previously, underwent knee surgery. Postoperatively, she received oral oxycodone 60mg twice daily with immediate-release oxycodone 10–15mg every 2–5 hours for breakthrough pain. She was transferred to an acute-care nursing facility 7 days after surgery and, during transfer, her twice-daily oxycodone dose was inadvertently discontinued and immediate-release oxycodone was reduced to 5mg every 4 hours as needed. The next day, she presented to the emergency department with acute-onset dyspnoea and mild chest pain [time to reaction onset not clearly stated]; the error in her discharge drug orders was not found until shortly before readmission. She reported nausea and back pain. On examination, she had a BP of 170/106mm Hg, a HR of 146 beats/min, and an oxygen saturation of 94% while receiving oxygen 15L. She was pale, diaphoretic, anxious, and in acute respiratory distress. She had an audible soft systolic murmur and diffuse crackles in the lower two thirds of her lungs. An ECG revealed tachycardia with ST-segment elevation in the precordial leads. She had elevated troponin T and creatine kinase-MB isoenzyme levels. A chest x-ray revealed bilateral pulmonary infiltrates. Her B-type natriuretic level was > 2300 pg/mL (reference ≤ 96 pg/mL). The woman refused tracheal intubation so her respiratory failure due to pulmonary oedema was treated with bilevel positive airway pressure and diuretics. Morphine, aspirin, metoprolol, enalapril, heparin and nitroglycerin [glyceryl trinitrate] were given. Left ventriculography showed an ejection fraction of 26%, with severe hypokinesis of her anterolateral, posterolateral, diaphragmatic and basal septal segments. She had new-onset mitral regurgitation. Shortly after readmission, her postoperative opioid regimen was restarted. The day after admission, she developed arterial hypotension and received dopamine; she was also treated for pneumonia. On hospital day 4, an ECG showed her mitral regurgitation resolved and her left ventricular systolic function had completely recovered (ejection fraction 65%–70%). Author comment: "Because opioid withdrawal has been linked to increased sympathetic activity, we believe that increased sympathetic activity secondary to opioid withdrawal probably contributed to the development of [cardiomyopathy] in this patient." Rivera JM, et al. "Broken heart syndrome" after separation (from OxyContin) 801042331 Mayo Clinic Proceedings 81: 825-828, No. 6, Jun 2006 - USA
» Editorial comment: This case was previously reported as an abstract [see Reactions 1103, p.12; 801026628]
0114-9954/10/1112-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 29 Jul 2006 No. 1112
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