title: Hypothalamic-pituitary-adrenal axis hypersensitivity to naloxone in opioid dependence: a case of naloxone-induced withdrawal.
abstract: A case of opioid withdrawal precipitated in an opioid-dependent person by low plasma levels of naloxone is presented. In this patient, changes were observed in the hypothalamic-pituitary-adrenal (HPA) axis that preceded the clinical symptoms and adrenergic signs of withdrawal. Plasma naloxone levels were strongly correlated with plasma cortisol levels (P < .0001, R2 = .73, r = .85). In addition, these neuroendocrine changes persisted after adrenergic changes and clinical symptoms had been ameliorated by administration of a short-acting opioid agonist. It is suggested that the HPA axis is a more sensitive indicator of opioid withdrawal than the adrenergic system.
authors.affiliation: The Biology of Addictive Diseases Laboratory, The Rockefeller University, New York, NY 10021, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Culpepper-Morgan
authors.forename: M J
authors.initials: MJ
authors.lastname: Kreek
mesh_terms: D004342:Drug Hypersensitivity / Q000209:etiology*; D005260:Female; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000276:immunology*; D008875:Middle Aged; D009019:Morphinans; D009270:Naloxone / Q000009:adverse effects*; D009292:Narcotic Antagonists / Q000009:adverse effects; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000276:immunology*; D013375:Substance Withdrawal Syndrome; D019966:Substance-Related Disorders / Q000276:immunology*
chemical_list: D009019:Morphinans; D009292:Narcotic Antagonists; D009270:Naloxone