Opioid overdose in advanced cancer patients antagonized by nalox- one: a report of 15 cases

1 2 The Second Cadre Ward, General Hospital of Beijing Military Command, Beijing 100700, China Abstract Objective: To analyze the clinical characteristics of opioid overdose in naloxone-antagonized advanced cancer pa- tients. Methods: Fifteen patients with moderate to severe cancer pain were diagnosed with opioid overdose. Five of the patients were treated with transdermal fentanyl, six with prolonged-release morphine sulfate tablets, and four with prolonged-release oxycodone hy- drochloride tablets. Naloxone was immediately administered upon discovery of opioid overdose. The reasons behind opioid overdose as well as the naloxone efficacy and patient prognosis were investigated. Results: In the patients of the group, the equivalent dosage of morphine, the treatment dosage is 10 mg/d to 640 mg/d, and the median dosage is 360 mg/d. The therapeutic dose of naloxone is 0.2 mg to 0.8 mg, and the median dosage is 0.4 mg. After naloxone use, the pupils of the patients were recovered in the first few min- utes, and respiratory depression improved within 10 min to 30 min. However, blood pressure recovery was slow for at least 1 hour. Two fever-afflicted patients were diagnosed with transdermal fentanyl overdose and impaired liver function, which exhibited rapid deteriora- tion immediately before the opioid overdose. Seven patients with poor pain control were diagnosed with opioid overdose during drug ti- tration. These patients were given poor prognosis, and their median overall survival time was 1.9 months. Conclusion: Opioid over- dose, which is shown to be common in advanced cancer patients, can be safely and effectively treated by naloxone. Early diagnosis and treatment of this condition would significantly improve the quality of pain control for the patient.