Opioid toxicity due to CNS depressant polypharmacy: A case report.
Christine LeeAnnabelle WansonSarah FrangouDavid ChongKatelyn C HalpapePublished in: The mental health clinician (2021)
The interaction between methadone and central nervous system depressants can cause serious adverse effects, including profound sedation, respiratory depression, coma, and death. This poses a challenge in the treatment of patients with concurrent psychiatric and substance use disorders as the combined use is often unavoidable. We report a case of a patient with opioid use disorder, mood disorder unspecified, chronic pain, and chronic obstructive pulmonary disease who experienced 2 serious episodes of CNS and respiratory depression due to polypharmacy-induced opioid toxicity. Careful consideration of pharmacokinetics, pharmacodynamics, and patient-specific factors was imperative to identify the suspected contributing medications: methadone, lorazepam, divalproex, gabapentin, and cyclobenzaprine. Cognitive and system factors that contributed to these adverse events and strategies to mitigate risk of recurrence were also identified.
Keyphrases
- chronic pain
- chronic obstructive pulmonary disease
- pain management
- sleep quality
- depressive symptoms
- blood brain barrier
- oxidative stress
- diabetic rats
- mental health
- bipolar disorder
- case report
- high glucose
- intellectual disability
- respiratory tract
- adverse drug
- locally advanced
- drug induced
- spinal cord
- replacement therapy
- extracorporeal membrane oxygenation
- autism spectrum disorder
- oxide nanoparticles