Opioid substitution therapy or hidden opioids are a minefield for nalmefene: an atypical case series of 11 patients in Lorraine.
Opioid antagonists such as naltrexone and nalmefene are used in drug therapy for alcoholism. Nalmefene, approved in Europe in February 2013 for the reduction of alcohol consumption, is used in patients with alcohol dependence. We report 11 cases of opioid withdrawal syndrome after a single dose of nalmefene in patients usually treated with methadone, buprenorphine, but also with fentanyl or loperamide. Nalmefene is both a partial agonist and an antagonist of opioid receptors. Regarding to its opioid antagonist activity, nalmefene is contraindicated in patients with an opioid treatment. Therefore, when prescribing or delivering nalmefene, healthcare professionals need to be vigilant about any type of opioid exposure, even masked or hidden, to avoid these potential life-threatening syndromes.
Centre Régional de Pharmacovigilance de Lorraine, Laboratoire de Pharmacologie Clinique et de Toxicologie, CHRU de Nancy, Hôpital Central, 29 avenue du Maréchal de Lattre de Tassigny, CO 60034, 54035, Nancy cedex, France.
Melissa
M
Yéléhé-Okouma
Service de Médecine L / Addictologie CHRU de Nancy, Hôpitaux de Brabois - Bâtiment Philippe Canton, Rue du Morvan, 54500, Vandœuvre-lès-Nancy, France.
Hervé
H
Martini
Service de Réanimation Médicale, CHRU de Nancy, Hôpital Central, 29 avenue du Maréchal de Lattre de Tassigny, CO 60034, 54035, Nancy cedex, France.
Jérémie
J
Lemarié
Service de Réanimation Médicale, Hôpital de Mercy, CHR Metz-Thionville, 1, allée du château, CS 45001, 57085, Metz cedex 03, France.
Pierre
P
Labroca
Centre Régional de Pharmacovigilance de Lorraine, Laboratoire de Pharmacologie Clinique et de Toxicologie, CHRU de Nancy, Hôpital Central, 29 avenue du Maréchal de Lattre de Tassigny, CO 60034, 54035, Nancy cedex, France.
Nadine
N
Petitpain
Centre d'Addictovigilance de Nancy, Hôpital Central, Pavillon Bruillatre-Balbatre, 29, avenue du Maréchal de Lattre de Tassigny, CO 60034, 54035, NANCY Cedex, France.
Valérie
V
Gibaja
Service de Médecine L / Addictologie CHRU de Nancy, Hôpitaux de Brabois - Bâtiment Philippe Canton, Rue du Morvan, 54500, Vandœuvre-lès-Nancy, France.
François
F
Paille
Centre Régional de Pharmacovigilance de Lorraine, Laboratoire de Pharmacologie Clinique et de Toxicologie, CHRU de Nancy, Hôpital Central, 29 avenue du Maréchal de Lattre de Tassigny, CO 60034, 54035, Nancy cedex, France.
Pierre
http://orcid.org/0000-0002-0598-7508
P
Gillet
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000175:diagnosis / Q000188:drug therapy*; D000701:Analgesics, Opioid / Q000009:adverse effects*; D005260:Female; D005602:France / Q000453:epidemiology; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D010195:Pancreatitis / Q000139:chemically induced; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000188:drug therapy*
D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009271:Naltrexone; C038981:nalmefene
nalmefene; opioid substitution therapy; opioid withdrawal syndrome