A clinical study on administration of opioid antagonists in terminal cancer patients: 7 patients receiving opioid antagonists following opioids among 2443 terminal cancer patients receiving opioids

Yoshihiro Uekuzu, Takashi Higashiguchi, Akihiko Futamura, Akihiro Ito, Naoharu Mori, Miyo Murai, Hiroshi Ohara, Hiroko Awa, Takeshi Chihara

Research output: Contribution to journalArticle

Abstract

There have been few detailed reports on respiratory depression due to overdoses of opioids in terminal cancer patients. We investigated the situation of treatment with opioid antagonists for respiratory depression that occurred after administration of opioid at optimal doses in terminal cancer patients, to clarify pathological changes as well as causative factors. In 2443 terminal cancer patients receiving opioids, 7 patients (0.3%) received opioid antagonists: 6, morphine (hydrochloride, 5; sulfate, 1); 1, oxycodone. The median dosage of opioids was 13.3 mg/d, as converted to morphine injection. Respiratory depression occurred on this daily dose in 4 patients and after changed dose and route in 3 patients. Opioids were given through the vein in 6 patients and by the enteral route in 1 patient. Concomitant drugs included nonsteroidal anti-inflammatory drugs in 3 patients and zoledronic acid in 2 patients. In morphine-receiving patients, renal functions were significantly worsened at the time of administration of an opioid antagonist than the day before the start of opioid administration. These findings indicate that the proper use of opioids was safe and acceptable in almost all terminal cancer patients. In rare cases, however, a risk toward respiratory depression onset is indicated because morphine and morphine-6-glucuronide become relatively excessive owing to systemic debility due to disease progression, especially respiratory and renal dysfunctions. At the onset of respiratory depression, appropriate administration of an opioid antagonist mitigated the symptoms. Thereafter, opioid switching or continuous administration at reduced dosages of the same opioids prevented the occurrence of serious adverse events.

Original languageEnglish
Pages (from-to)278-283
Number of pages6
JournalBiological and Pharmaceutical Bulletin
Volume40
Issue number3
DOIs
Publication statusPublished - 01-01-2017

Fingerprint

Narcotic Antagonists
Opioid Analgesics
Neoplasms
Respiratory Insufficiency
Morphine
zoledronic acid
Clinical Studies
Oxycodone
Kidney
Pharmaceutical Preparations
Sulfates
Small Intestine
Disease Progression
Veins
Anti-Inflammatory Agents

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Pharmaceutical Science

Cite this

@article{7d7e2aece9e14c8da34db56e88cf2997,
title = "A clinical study on administration of opioid antagonists in terminal cancer patients: 7 patients receiving opioid antagonists following opioids among 2443 terminal cancer patients receiving opioids",
abstract = "There have been few detailed reports on respiratory depression due to overdoses of opioids in terminal cancer patients. We investigated the situation of treatment with opioid antagonists for respiratory depression that occurred after administration of opioid at optimal doses in terminal cancer patients, to clarify pathological changes as well as causative factors. In 2443 terminal cancer patients receiving opioids, 7 patients (0.3{\%}) received opioid antagonists: 6, morphine (hydrochloride, 5; sulfate, 1); 1, oxycodone. The median dosage of opioids was 13.3 mg/d, as converted to morphine injection. Respiratory depression occurred on this daily dose in 4 patients and after changed dose and route in 3 patients. Opioids were given through the vein in 6 patients and by the enteral route in 1 patient. Concomitant drugs included nonsteroidal anti-inflammatory drugs in 3 patients and zoledronic acid in 2 patients. In morphine-receiving patients, renal functions were significantly worsened at the time of administration of an opioid antagonist than the day before the start of opioid administration. These findings indicate that the proper use of opioids was safe and acceptable in almost all terminal cancer patients. In rare cases, however, a risk toward respiratory depression onset is indicated because morphine and morphine-6-glucuronide become relatively excessive owing to systemic debility due to disease progression, especially respiratory and renal dysfunctions. At the onset of respiratory depression, appropriate administration of an opioid antagonist mitigated the symptoms. Thereafter, opioid switching or continuous administration at reduced dosages of the same opioids prevented the occurrence of serious adverse events.",
author = "Yoshihiro Uekuzu and Takashi Higashiguchi and Akihiko Futamura and Akihiro Ito and Naoharu Mori and Miyo Murai and Hiroshi Ohara and Hiroko Awa and Takeshi Chihara",
year = "2017",
month = "1",
day = "1",
doi = "10.1248/bpb.b16-00715",
language = "English",
volume = "40",
pages = "278--283",
journal = "Biological and Pharmaceutical Bulletin",
issn = "0918-6158",
publisher = "Pharmaceutical Society of Japan",
number = "3",

}

TY - JOUR

T1 - A clinical study on administration of opioid antagonists in terminal cancer patients

T2 - 7 patients receiving opioid antagonists following opioids among 2443 terminal cancer patients receiving opioids

AU - Uekuzu, Yoshihiro

AU - Higashiguchi, Takashi

AU - Futamura, Akihiko

AU - Ito, Akihiro

AU - Mori, Naoharu

AU - Murai, Miyo

AU - Ohara, Hiroshi

AU - Awa, Hiroko

AU - Chihara, Takeshi

PY - 2017/1/1

Y1 - 2017/1/1

N2 - There have been few detailed reports on respiratory depression due to overdoses of opioids in terminal cancer patients. We investigated the situation of treatment with opioid antagonists for respiratory depression that occurred after administration of opioid at optimal doses in terminal cancer patients, to clarify pathological changes as well as causative factors. In 2443 terminal cancer patients receiving opioids, 7 patients (0.3%) received opioid antagonists: 6, morphine (hydrochloride, 5; sulfate, 1); 1, oxycodone. The median dosage of opioids was 13.3 mg/d, as converted to morphine injection. Respiratory depression occurred on this daily dose in 4 patients and after changed dose and route in 3 patients. Opioids were given through the vein in 6 patients and by the enteral route in 1 patient. Concomitant drugs included nonsteroidal anti-inflammatory drugs in 3 patients and zoledronic acid in 2 patients. In morphine-receiving patients, renal functions were significantly worsened at the time of administration of an opioid antagonist than the day before the start of opioid administration. These findings indicate that the proper use of opioids was safe and acceptable in almost all terminal cancer patients. In rare cases, however, a risk toward respiratory depression onset is indicated because morphine and morphine-6-glucuronide become relatively excessive owing to systemic debility due to disease progression, especially respiratory and renal dysfunctions. At the onset of respiratory depression, appropriate administration of an opioid antagonist mitigated the symptoms. Thereafter, opioid switching or continuous administration at reduced dosages of the same opioids prevented the occurrence of serious adverse events.

AB - There have been few detailed reports on respiratory depression due to overdoses of opioids in terminal cancer patients. We investigated the situation of treatment with opioid antagonists for respiratory depression that occurred after administration of opioid at optimal doses in terminal cancer patients, to clarify pathological changes as well as causative factors. In 2443 terminal cancer patients receiving opioids, 7 patients (0.3%) received opioid antagonists: 6, morphine (hydrochloride, 5; sulfate, 1); 1, oxycodone. The median dosage of opioids was 13.3 mg/d, as converted to morphine injection. Respiratory depression occurred on this daily dose in 4 patients and after changed dose and route in 3 patients. Opioids were given through the vein in 6 patients and by the enteral route in 1 patient. Concomitant drugs included nonsteroidal anti-inflammatory drugs in 3 patients and zoledronic acid in 2 patients. In morphine-receiving patients, renal functions were significantly worsened at the time of administration of an opioid antagonist than the day before the start of opioid administration. These findings indicate that the proper use of opioids was safe and acceptable in almost all terminal cancer patients. In rare cases, however, a risk toward respiratory depression onset is indicated because morphine and morphine-6-glucuronide become relatively excessive owing to systemic debility due to disease progression, especially respiratory and renal dysfunctions. At the onset of respiratory depression, appropriate administration of an opioid antagonist mitigated the symptoms. Thereafter, opioid switching or continuous administration at reduced dosages of the same opioids prevented the occurrence of serious adverse events.

UR - http://www.scopus.com/inward/record.url?scp=85014467555&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014467555&partnerID=8YFLogxK

U2 - 10.1248/bpb.b16-00715

DO - 10.1248/bpb.b16-00715

M3 - Article

C2 - 27980244

AN - SCOPUS:85014467555

VL - 40

SP - 278

EP - 283

JO - Biological and Pharmaceutical Bulletin

JF - Biological and Pharmaceutical Bulletin

SN - 0918-6158

IS - 3

ER -