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No Antagonists for an Antagonist: One Pitfall of Chronic Oral Low-Dose Naltrexone No Antagonists for an Antagonist

Title
No Antagonists for an Antagonist: One Pitfall of Chronic Oral Low-Dose Naltrexone No Antagonists for an Antagonist
Publication Type
Abstract/Poster/Letter
Research Type
Human
Reported as
Case Report/Series/Restrospective Study
Date
December 01, 2015
Authors
Bolash R. and Casserly, E.
Institution
The Cleveland Clinic
Link
Abstract

A 48-year-old man was admitted for management of a perforated duodenal ulcer with intraabdominal free air. For ten years, he had chronic abdominal pain following an open repair of an abdominal aortic aneurysm and was treated with "low dose" Naltrexone 1.5mg per day for 3 years, with satisfactory efficacy. Upon admission, the patient was administered I.V. opiates while the medical evaluation of the intraabdominal free air was performed. A duodenal ulcer was found, and the decision was made to manage the free air non-operatively.  Despite the dose escalation of I.V. fentanyl 4,500 mcg per day, and hydromorphone to 47mg per day, his acute pain remained uncontrolled. We were suprised to observe that an opiate-naive patient was refractory to the analgesic, sedative, or respiratory depresant effects of I.V. opiates with liberal dose escalation.