Demographic and Clinical Characteristics of 907 Cases with Naltrexone Intoxication; a 14-Year Cross-Sectional Study
Archives of Academic Emergency Medicine,
Vol. 10 No. 1 (2022),
Introduction: Opioids have been the leading cause of death from poisoning in Iran for several years. This study aimed to evaluate the clinical and para-clinical presentations of naltrexone intoxication, its toxic dose, and its epidemiological properties.
Methods: This retrospective cross-sectional study was conducted on medical records of patients presenting to Toxicology Department of Loghman Hakim Hospital, Tehran, Iran, following naltrexone intoxication, from 2002 to 2016. Patients’ demographic and laboratory data, clinical signs, supposed ingested dose, and intent of naltrexone consumption were collected, analyzed, and then interpreted.
Results: 907 patients with the mean age of 36.6 ±11.7 years were evaluated (94.3% male). The mean amount of naltrexone consumed by the intoxicated patients reported in the medical records was 105.8 ± 267.8 mg. One hundred thirty patients (14.3%) used naltrexone to treat substance use disorder. Two hundred eighty-seven poisoned patients (31.6%) were current opium users who intentionally or unintentionally used naltrexone concomitantly. The most common symptoms observed in these patients were agitation (41.8%), vomiting (16.4%), and nausea (14.8%). Among patients with naltrexone poisoning, 25 patients were intubated (2.8%), and three passed away. Aspartate aminotransferase (AST) levels were significantly higher in patients intoxicated with naltrexone who needed intubation (p = 0.02).
Conclusion: The probability of intubation of cases with naltrexone intoxication was associated with AST elevation. It seems that, the number of intensive care unit (ICU) admissions and mortality rates are not high among these patients.
- aspartate aminotransferases
- cross-sectional studies
- retrospective studies
How to Cite
Kirchmayer U, Davoli M, Verster A. Naltrexone maintenance treatment for opioid dependence. Cochrane Database Syst Rev. 2003(2).
Amin‐Esmaeili M, Rahimi‐Movaghar A, Sharifi V, Hajebi A, Radgoodarzi R, Mojtabai R, et al. Epidemiology of illicit drug use disorders in Iran: prevalence, correlates, comorbidity and service utilization results from the Iranian Mental Health Survey. Addiction. 2016;111(10):1836-47.
Shadnia S, Esmaily H, Sasanian G, Pajoumand A, Hassanian-Moghaddam H, Abdollahi M. Pattern of acute poisoning in Tehran-Iran in 2003. Hum Exp Toxicol. 2007;26(9):753-6.
Ghane T, Zamani N, Hassanian-Moghaddam H, Beyrami A, Noroozi A. Lead poisoning outbreak among opium users in the Islamic Republic of Iran, 2016–2017. Bull World Health Organ. 2018;96(3):165.
Merz F. United Nations Office on Drugs and Crime: World Drug Report 2017. 2017. SIRIUS. 2018;2(1):85-6.
Hassanian-Moghaddam H. An educational and research opportunity for the largest university hospital poison control centers; Tehran and Cairo. Egypt J Forensic Sci. 2013;2(3):64-5.
Strang J, McCambridge J, Best D, Beswick T, Bearn J, Rees S, et al. Loss of tolerance and overdose mortality after inpatient opiate detoxification: follow up study. Bmj. 2003;326(7396):959-60.
Gibson AE, Degenhardt LJ. Mortality related to pharmacotherapies for opioid dependence: a comparative analysis of coronial records. Drug alcohol Rev. 2007;26(4):405-10.
Hassanian-Moghaddam H, Afzali S, Pooya A. Withdrawal syndrome caused by naltrexone in opioid abusers. Hum Exp Toxicol. 2014;33(6):561-7.
Nelson L, Howland M, Lewin N, Smith S, Goldfrank L, Hoffman R. Chapter 4: Principles of Managing the Acutely Poisoned or Overdosed Patient. Goldfrank's Toxicologic Emergencies, 11th ed New York, NY: McGraw-Hill Education Online edition Accessed September. 2019;25:2021.
Pope JF. Clinical Management of Poisoning and Drug Overdose. Clin Pediatr. 1998;37(7):457.
Rahbar M, Badsar AR, Mahmanzar Ch, Fallah M. The Study of the Demographic and Clinical and Laboratory Findings in Naltrexone Poisoning Patients Admitted to Razi Hospital, Rasht, During 2007-08. Iran J Toxicol. 2012;17(6):649-654.
Mokri A. Brief overview of the status of drug abuse in Iran. Arch Iran Med. 2002;5(3):184-190.
Yen M-H, Ko H-C, Tang F-I, Lu R-B, Hong J-S. Study of hepatotoxicity of naltrexone in the treatment of alcoholism. Alcohol. 2006;38(2):117-20.
Vagenas P, Di Paola A, Herme M, Lincoln T, Skiest DJ, Altice FL, et al. An evaluation of hepatic enzyme elevations among HIV-infected released prisoners enrolled in two randomized placebo-controlled trials of extended release naltrexone. J Subst Abuse Treat. 2014;47(1):35-40.
Brewer C, Wong VS. Naltrexone: report of lack of hepatotoxicity in acute viral hepatitis, with a review of the literature. Addict biol. 2004;9(1):81-7.
Marrazzi MA, Wroblewski JM, Kinzie J, Luby ED. High-dose naltrexone and liver function safety. Am J Addict. 1997;6(1):21-9.
Mitchell JE, Morley JE, Levine AS, Hatsukami D, Gannon M, Pfohl D. High-dose naltrexone therapy and dietary counseling for obesity. Biol psychiatry. 1987;22(1):35-42.
Pfohl DN, Allen JI, Atkinson RL, Knopman DS, Malcolm RJ, Mitchell JE, et al. Naltrexone hydrochloride (Trexan): a review of serum transaminase elevations at high dosage. NIDA Res Monogr. 1986;67:66-72.
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