Management of precipitated opiate withdrawal syndrome induced by nalmefene mistakenly prescribed in opiate-dependent patients: a review for clinicians.
Nalmefene, a long-acting µ-opioid antagonist approved to treat alcohol use disorder, is occasionally mistakenly prescribed to opiate-dependent or opioid-treated patients. We review recent literature on drug-drug interactions between nalmefene and opioids that lead to precipitated opioid withdrawal, and focus on its management and planning for care at discharge. Areas covered: This article provides a brief and comprehensive review of management of precipitated opioid withdrawal syndrome when nalmefene is associated with an opioid, whether misused or legally prescribed. Expert opinion: When treating an opiate-dependent patient with co-occurring alcohol use disorder, both conditions need to be a focus of clinical attention. New drugs for alcohol use disorder have been approved, but must be given cautiously and with a full understanding of their potential drug-drug interactions with opioid medications. Opiate-dependent patients should be intensively monitored for risk factors of alcohol use disorder and should be continuously motivated for treatment maintenance. When nalmefene is administered to opiate-dependent patients, acute opioid withdrawal syndrome may occur. Management of precipitated acute opioid withdrawal may include short or long-acting µ-opioid agonists during hospitalization, in addition to supportive treatment. The best management of polydrug abusers is based on a multidisciplinary approach, which should be pursued and improved through continuing medical education.
a Service d'Addictologie , Centre Hospitalo-Universitaire Toulouse-Purpan , Toulouse , France.|b Centre Antipoison et de Toxicovigilance , Centre Hospitalo-Universitaire Toulouse-Purpan , Toulouse , France.|c Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1027 , Université Paul Sabatier , Toulouse , France.
Nicolas
N
Franchitto
a Service d'Addictologie , Centre Hospitalo-Universitaire Toulouse-Purpan , Toulouse , France.
Benedicte
B
Jullian
a Service d'Addictologie , Centre Hospitalo-Universitaire Toulouse-Purpan , Toulouse , France.
Juliette
J
Salles
b Centre Antipoison et de Toxicovigilance , Centre Hospitalo-Universitaire Toulouse-Purpan , Toulouse , France.
Fanny
F
Pelissier
d Département de Psychiatrie et d'Addictologie , Centre Hospitalo-Universitaire Lille , Lille , France.
Benjamin
B
Rolland
D000437:Alcoholism / Q000150:complications / Q000188:drug therapy; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000818:Animals; D004347:Drug Interactions; D006801:Humans; D009271:Naltrexone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D009292:Narcotic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D009293:Opioid-Related Disorders / Q000150:complications*; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome / Q000209:etiology* / Q000628:therapy
D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009271:Naltrexone; C038981:nalmefene
Addiction medicine; nalmefene; opioid maintenance therapy; precipitated opioid withdrawal