ToxicologyMassive OxyContin ingestion refractory to naloxone therapy*
Introduction
OxyContin (oxycodone hydrochloride controlled release) has recently received attention as a new drug of abuse.1 However, there is little medical literature describing abuse or poisoning with OxyContin.2, 3 Oxycodone is primarily a μ-opioid agonist that has a similar abuse potential as morphine.4, 5 Compared with oral morphine, oxycodone has 1.5 to 2 times the analgesic potency.6 The tablet OxyContin is formulated with a coating that allows for controlled release, a property that might be therapeutically beneficial.2 However, in overdose conditions such a controlled-release formulation would be expected to cause prolonged toxicity. We report a case of massive OxyContin ingestion in which the patient experienced prolonged respiratory depression refractory to high-dose naloxone therapy.
Section snippets
Case report
After a brief, witnessed, generalized convulsion, paramedics arrived to find a 45-year-old woman lying on the ground with a nearly full bottle containing OxyContin. She was cyanotic with a respiratory rate of 6 breaths/min, had pinpoint pupils, and had frequent premature ventricular contractions (PVCs). Two milligrams of naloxone were administered intravenously, with full reversal of her depressed level of consciousness, hypoventilation, and miosis. She told the paramedics that she had ingested
Discussion
This patient had severe opioid intoxication from a massive ingestion of a controlled-release formulation of oxycodone. The most striking aspects of this case were the prolonged and refractory nature of the patient's respiratory compromise. These features were most likely the result of the massive ingestion and sustained-release formulation rather than being a unique property of oxycodone. In addition, the opioid effect of oxycodone on the gastrointestinal tract to decrease transit time and
References (10)
- et al.
A review of oxycodone's clinical pharmacokinetics and pharmacodynamics
J Pain Symptom Manage
(1993) - et al.
Problems with the use of oxycodone compound in patients with chronic pain
Pain
(1981) - et al.
Equianalgesic dose ratios for opioids: a critical review and proposals for long-term dosing
J Pain Symptom Manage
(2001) - et al.
Mu receptor binding of some commonly used opioids and their metabolites
Life Sci
(1991) The potent perils of a miracle drug
Time
(2001)
Cited by (23)
Systematic Review of Naloxone Dosing and Adverse Events in the Emergency Department
2023, Journal of Emergency MedicineInterest of take-home naloxone for opioid overdose
2018, TherapieEuropean Resuscitation Council Guidelines for Resuscitation 2015. Section 4. Cardiac arrest in special circumstances
2015, ResuscitationCitation Excerpt :The respiratory effects of opioids are reversed rapidly by the opiate antagonist naloxone. In severe respiratory depression caused by opioids, there are fewer adverse events when airway opening, oxygen administration and ventilation are carried out before giving naloxone283–289; The use of naloxone can prevent the need for intubation. The preferred route for giving naloxone depends on the skills of the rescuer: intravenous (IV), intramuscular (IM), subcutaneous (SC), intraosseous (IO) and intranasal (IN) routes are all suitable.290,291
European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution
2010, ResuscitationCitation Excerpt :The respiratory effects of opioids are reversed rapidly by the opiate antagonist naloxone. In severe respiratory depression caused by opioids, there are fewer adverse events when airway opening, oxygen administration and ventilation are carried out before giving naloxone.41–47 The use of naloxone can prevent the need for intubation.
Part 4: Advanced life support
2005, Resuscitation
- *
Address for reprints: Aaron Schneir, MD, California Poison Control System, San Diego Division, UCSD Medical Center #8925, 200 West Arbor Drive, San Diego, CA 92103-8925; 858-715-6308, fax 858-715-6361; E-mail [email protected]