Unintentional rapid opioid detoxification: case report.
BACKGROUND
Naltrexone is a competitive opioid antagonist and is often used to maintain abstinence in detoxified opioid dependent patients. However, it can precipitate an accelerated withdrawal when ingested by an individual with concurrent opioid use.


METHODS
We report the case of a 28 year old male with opioid dependence syndrome presenting with chaotic symptoms following ingestion of naltrexone. Symptomatology, management is described and literature in this area is reviewed.


RESULTS
Accidental or surreptitious ingestion of naltrexone in a patient with concurrent opioid use can precipitate symptoms typical of opioid withdrawal in addition to other varying symptomatology. Most cases would require sedation and management of concurrent vomiting and diarrhoea.


CONCLUSIONS
Clinicians, especially those providing substance abuse and emergency care, need to be aware of the possibility of an accelerated and possibly life threatening withdrawal associated with naltrexone ingestion in an incompletely detoxified patient with opioid dependence.
Singh
Shubh M
SM
Department of Psychiatry, Gian Sagar Medical College and Hospital, Banur, Punjab, India. shubhmohan@gmail.com
Sharma
Balkishan
B
D000328:Adult; D003244:Consciousness Disorders / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy; D003422:Critical Care; D003975:Diazepam / Q000008:administration & dosage; D004347:Drug Interactions; D004636:Emergency Service, Hospital; D004829:Epilepsy, Generalized / Q000139:chemically induced / Q000628:therapy; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D007262:Infusions, Intravenous; D008297:Male; D009271:Naltrexone / Q000009:adverse effects* / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D009294:Narcotics / Q000009:adverse effects*; D009460:Neurologic Examination / Q000187:drug effects; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D011331:Private Practice; D015813:Substance Abuse Detection; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy
D013287:Illicit Drugs; D009292:Narcotic Antagonists; D009294:Narcotics; D009271:Naltrexone; D003975:Diazepam