Intrathecal D-Ala2-D-Leu5-enkephalin (DADL) restores analgesia in a patient analgetically tolerant to intrathecal morphine sulfate.
DADL was administered to a patient who was analgetically tolerant to continuously infused, intrathecal morphine sulfate. DADL restored analgesia without respiratory depression but opiate withdrawal syndrome was not prevented. Somnolence, not responsive to naloxone but completely reversed with morphine, was seen as an idiosyncratic mu receptor opiate withdrawal symptom. Clonidine hydrochloride and decreasing doses of oral morphine were used to successfully treat the withdrawal syndrome, including somnolence. Further research is indicated to verify the findings of this one patient and investigate the efficacy of DADL to provide analgesia for morphine-tolerant patients.
D000368:Aged; D002277:Carcinoma / Q000503:physiopathology / Q000556:secondary; D003000:Clonidine / Q000627:therapeutic use; D004361:Drug Tolerance; D004743:Enkephalin, Leucine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016308:Enkephalin, Leucine-2-Alanine; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D009270:Naloxone / Q000627:therapeutic use; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology; D011957:Receptors, Opioid / Q000187:drug effects; D017465:Receptors, Opioid, delta; D017450:Receptors, Opioid, mu; D012888:Skull Neoplasms / Q000503:physiopathology / Q000556:secondary; D013125:Spinal Neoplasms / Q000503:physiopathology / Q000556:secondary; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy / Q000209:etiology; D013964:Thyroid Neoplasms
D011957:Receptors, Opioid; D017465:Receptors, Opioid, delta; D017450:Receptors, Opioid, mu; D009270:Naloxone; D004743:Enkephalin, Leucine; D016308:Enkephalin, Leucine-2-Alanine; D009020:Morphine; D003000:Clonidine