Severe opioid withdrawal syndrome after a single dose of nalmefene.

摘要: Case 1 A 43-year-old man was brought by ambulance to the emergency department (ED) with severe agitation and clinical signs of opioid withdrawal approximately 2 h after a single dose nalmefene (Selincro®, Lundbeck (Switzerland)) for his alcohol dependence. His medical history included paranoid schizophrenia, depression, codeine He consumed up two bottles Makatussin®Hustentropfen (GebropharmaAG, Liestal, Switzerland), codeine-containing cough medicine, per day (equivalent 636 mg base day). The psychiatrist who prescribed unaware extent patient’s abuse. patient needed high bolus doses midazolam (cumulative 25 mg, commenced in community prior transfer ED), morphine (10 mg), propofol (40 mg) treat agitation. transferred intensive care unit (ICU) further monitoring treatment, where he received midazolam, propofol, morphine, clonidine continuous intravenous infusion. After first 12 h, it possible withdraw propofol; however, were continued 48 h. Attempts stop medication before this point resulted reemergence symptoms. 3 days ICU we able psychiatric inpatient services.