Oxycodone-induced neurotoxicity secondary, to concurrent voriconazole use in a patient with cancer

Lana Alghothani, MD; Jillian Gustin, MD

doi:10.5055/jom.2017.0381

Authors

Lana Alghothani, MD
Jillian Gustin, MD

DOI:

https://doi.org/10.5055/jom.2017.0381

Keywords:

neurotoxicity, oxycodone, voriconazole, cancer

Abstract

Chronic pain is common in patients with underlying malignancy with prevalence of up to 70 percent in those with advanced disease. Opioids are often used for those with both active disease and chronic cancer-related pain. In high-risk patients with hematologic malignancies and pneumonia, the Infectious Diseases Society of America recommends empiric antifungal therapy, often with voriconazole or another similar azole agent. Thus, patients with cancer are commonly on medications, such as antifungals, that have the potential to interact with opioids, causing adverse effects. Our case demonstrates severe neurotoxicity due to the concurrent use of voriconazole and oxycodone.

Author Biographies

Lana Alghothani, MD

Division of Pulmonary and Critical, Care Medicine, Department of Internal Medicine, the Ohio, State University Wexner Medical Center, Columbus, Ohio

Jillian Gustin, MD

Division of Palliative Medicine, Department of Internal Medicine, the Ohio State University, Wexner Medical Center, Columbus, Ohio

References

Goudas LC, Bloch R, Gialeli-Goudas M, et al.: The epidemiology of cancer pain. Cancer Invest. 2005; 23:182-190.

Freifeld AG, Bow EJ, Sepkowitz KA, et al.: Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011; 52: 427-431.

Leow KP, Smith MT, Williams B, et al.: Single-dose and steady-state pharmacokinetics and pharmacodynamics of oxycodone in patients with cancer. Clin Pharmacol Ther. 1992; 52: 487-495.

Lalovic B, Kharasch E, Hoeffer C, et al.: Pharmacokinetics and pharmacodynamics of oral oxycodone in healthy human subjects: Role of circulating active metabolites. Clin Pharmacol Ther. 2006; 79: 461-479.

Liukas A, Kuusneimi K, Aantaa R, et al.: Plasma concentrations of oral oxycodone are greatly increased in the elderly. Clin Pharmacol Ther. 2008; 84: 462-467.

Smith HS: Opioid metabolism. Mayo Clin. Proc. 2009; 84: 613-624.

Hagelberg NM, Nieminen TH, Saari TI, et al.: Voriconazole drastically increases exposure to oral oxycodone. Eur J Clin Pharmacol. 2009; 65: 263-271.

Kotlinska-Lemiezek A, Klepstad P, Haugen DF: Clinically significant drug-drug interactions involving opioid analgesics used for pain treatment in patients with cancer: A systematic review. Drug Des Dev Ther. 2015; 9: 5255-5267.