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- W2315778869 abstract "55 year-old female with hypertension and obesity presented for a left patellar tendon repair. The patient’s preoperative medication included Contrave (naltrexone/bupropion), a new formulation indicated for weight loss in obese individuals. Despite utilization of regional anesthesia and high doses of opioids the patient’s intraoperative course was complicated by tachypnea and hypertension and her postoperative course by difficulty in controlling her pain. Opioids as well as adjunct medications including IV acetaminophen and gabapentin were started postoperatively, and were able to confer partial analgesia. Bupropion was continued as a separate agent. Adequate postoperative analgesia was achieved once the effects of the opioid antagonism subsided. Bupropion is a reuptake inhibitor of norepinephrine, a nicotinic antagonist, and activates pro-opiomelanocortin (POMC) neurons in the hypothalamus, which results in a downstream loss of appetite. POMC is regulated by endogenous opioids via negative feedback, thus naltrexone, an opioid antagonist, is added to bupropion. As naltrexone has a half-life of 5 hours, it would be prudent to discontinue Contrave at least 24 hours prior to procedures where opioids may be utilized during the perioperative period. Practitioners may attempt to “overcome” the naltrexone, by prescribing high dose opioids to manage post-operative pain, however, one must be cautious as the threshold necessary to overcome the antagonistic effects of naltrexone in a particular individual is poorly defined. Furthermore, the offset of the drug may be quite abrupt, which may also lead to respiratory depression secondary to the un-antagonized action of opioids. This is the first published case of Contrave complicating perioperative anesthetic and analgesic management. It is our recommendation to discontinue Contrave at least 24 hours prior to surgery, to continue bupropion during the perioperative period, and to re-initiate Contrave 7 days after cessation of opioid therapy." @default.
- W2315778869 created "2016-06-24" @default.
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- W2315778869 date "2016-04-01" @default.
- W2315778869 modified "2023-09-27" @default.
- W2315778869 title "(434) Considerations for perioperative Contrave (naltrexone HCl/bupropion HCl) administration" @default.
- W2315778869 doi "https://doi.org/10.1016/j.jpain.2016.01.411" @default.
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