Evaluation of Different Doses of Fentanyl in Controlling Agitation in Acute Opioid Withdrawal Syndrome Induced by Naltrexone Misuse

Abstract

Background: Opioid addiction is one of the problems in all human societies including our country (Iran). It causes several kinds of disability in individual performance. Inappropriate use of naltrexone drug addicts causes acute opioid withdrawal syndrome. Agitation is the prominent sign of this syndrome. The aim of this study was to elucidate the efficacious and safe dose of fentanyl in controlling agitation. Methods: In a clinical trial study, 45 eligible opioid addicted patients were evaluated. They were divided into 3 groups with different doses of fentanyl (50, 75, 100 µg). Each patient's agitation score was then measured by Richmond Agitation Sedation Scale (RASS). The values were compared between the 3 groups. Findings: The mean age of participants was 30.5 ± 7.3 years. There were no significant differences between the 3 groups in terms of the last opioid use, naltrexone consumption, and vital signs on arrival. RASS scores in all 3 groups were significantly reduced (P < 0.05) 9 hours after initiation of treatment. The changes RASS scores of the 3 groups had significant differences (P < 0.001). Patients receiving 100 µg fentanyl suffered severe drowsiness. All patients were discharged with no adverse effects. Conclusion: Bolus and maintenance doses of fentanyl have no significant effects on patients' vital signs. On the other hand, dose of 100 µg caused excessive sedation for patients. Therefore, fentanyl would be recommended at a dose of 75 or 50 µg to control agitation in acute opioid withdrawal syndrome following naltrexone misuse.

Keywords

• Fentanyl
• Naltrexone
• Agitation
• Acute opioid withdrawal syndrome