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Oral Morphine Overdose in a Cancer Patient Antagonized by Prolonged Naloxone Infusion

Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India

Roopesh Jain, MD

Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India

Himanshu Chauhan, MD

Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India

Deepak Gupta, MD

Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India

Seema Mishra, MD

Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India

Sushma Bhatnagar, MD

Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India, shumob{at}yahoo.com

An 80-year-old male was diagnosed with carcinoma in the lung with multiple bony metastases and had been prescribed pain medications as per World Health Organization analgesic ladder guidelines. However, he was not getting adequate pain relief and there were difficulties in titration of the morphine doses on an outpatient basis. Therefore, he was hospitalized for dose titration of oral morphine and was coprescribed amitriptyline and ranitidine. During the titration of the analgesic dose, he developed severe symptoms of morphine overdose. He was immediately treated with intravenous naloxone. After prolonged infusion of naloxone, he achieved his baseline vital parameters without any permanent sequel to the overdose event. This case report describes the possible causes of oral morphine overdose in the elderly and its successful treatment. To prevent such complications, one has to be very cautious of other factors such as drug interactions, particularly in the elderly.

Key Words: morphine overdose • morphine—amitriptyline interaction • overdose antagonism by naloxone

This version was published on October 1, 2008

American Journal of Hospice and Palliative Medicine®, Vol. 25, No. 5, 401-405 (2008)
DOI: 10.1177/1049909108319260


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