Reduced analgesic effect of opioids and withdrawal symptoms after use of naldemedine: a report of two cases

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  • ESHIMA Misa
    Department of Anesthesiology, Kurume University School of Medicine
  • YAMADA Shinichi
    Department of Pain Clinic and Palliative Care, Saga University Hospital
  • GOBARU Yui
    Department of Anesthesiology, Kurume University School of Medicine
  • HYODO Ayako
    Department of Anesthesiology, Kurume University School of Medicine
  • NAGATA Tamaki
    Department of Anesthesiology, Kurume University School of Medicine
  • HIRAKI Teruyuki
    Department of Anesthesiology, Kurume University School of Medicine

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  • ナルデメジン併用後にオピオイドの鎮痛効果減弱や退薬症状が認められた2症例

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Abstract

<p>Case 1: A man in his 50s. He had been treated for lung adenocarcinoma and skull base metastasis. The dose of oxycodone was increased and naldemedine was started in combination. He continued to experience pain, and nausea and vomiting appeared. Naldemedine was suspected to have an antagonistic effect and was discontinued. From the next day, his nausea and vomiting disappeared. Case 2: A female in her 40s. She had multiple mass lesions due to multiple schwannomas in the dural sac and epidural mater. She had severe pain in the abdomen and both limbs. After controlling her pain with a fentanyl patch, her constipation worsened, and she was administered naldemedine. Within hours of taking naldemedine, she had nausea and terrible diarrhea. Two years later, she was diagnosed with a right cerebellar pontine angle tumor. Conclusion: When reduced analgesic effect and withdrawal symptoms are suspected after administration of naldemedine with an opioid, the patient should be evaluated for the possible presence of brain tumor.</p>

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