Oral morphine overdose in a cancer patient antagonized by prolonged naloxone infusion.
An 80-year-old male was diagnosed with carcinoma in the lung with multiple bony metastases and had been prescribed pain medications as per World Health Organization analgesic ladder guidelines. However, he was not getting adequate pain relief and there were difficulties in titration of the morphine doses on an outpatient basis. Therefore, he was hospitalized for dose titration of oral morphine and was coprescribed amitriptyline and ranitidine. During the titration of the analgesic dose, he developed severe symptoms of morphine overdose. He was immediately treated with intravenous naloxone. After prolonged infusion of naloxone, he achieved his baseline vital parameters without any permanent sequel to the overdose event. This case report describes the possible causes of oral morphine overdose in the elderly and its successful treatment. To prevent such complications, one has to be very cautious of other factors such as drug interactions, particularly in the elderly.
Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
Surjya
S
Upadhyay
Roopesh
R
Jain
Himanshu
H
Chauhan
Deepak
D
Gupta
Seema
S
Mishra
Sushma
S
Bhatnagar
D000284:Administration, Oral; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000378:metabolism / Q000493:pharmacokinetics; D001859:Bone Neoplasms / Q000150:complications / Q000556:secondary; D004334:Drug Administration Schedule; D004336:Drug Antagonism; D016903:Drug Monitoring; D062787:Drug Overdose / Q000188:drug therapy; D006207:Half-Life; D006801:Humans; D007262:Infusions, Intravenous; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D009020:Morphine / Q000009:adverse effects* / Q000378:metabolism / Q000493:pharmacokinetics; D009270:Naloxone / Q000008:administration & dosage / Q000009:adverse effects*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010166:Palliative Care / Q000379:methods; D012307:Risk Factors; D013810:Therapeutic Equivalency
D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone; D009020:Morphine