nalbuphine and Seizures

Neurotoxicity is frequent with vincristine treatment, but severe autonomic neuropathy is rare. A decreased activity of drug transporters in the presence of an interacting drug may favor such events by increasing systemic or tissue exposure to the drug. We encountered severe autonomic neuropathy and cholestasis in a child receiving vincristine, after the introduction of piperacillin-tazobactam. A causality assessment of the adverse reaction identified the antibiotic as the most probable cause of the observation. The patient was heterozygous for several common polymorphisms of ABCC2 (multidrug-related protein-2), CYP3A5, and ABCB1 (multidrug-related protein-1, P-glycoprotein), but their role in the toxicity cannot be ascertained.

Topics: Abdominal Pain; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; ATP Binding Cassette Transporter, Subfamily B; ATP Binding Cassette Transporter, Subfamily B, Member 1; Autonomic Nervous System Diseases; Biological Transport; Child; Cholestasis; Cyclophosphamide; Cytochrome P-450 CYP3A; Daunorubicin; Drug Combinations; Drug Interactions; Facial Pain; Female; Humans; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Multidrug Resistance-Associated Protein 2; Multidrug Resistance-Associated Proteins; Nalbuphine; Neoplasm Proteins; Neuralgia; Penicillanic Acid; Piperacillin; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Seizures; Tazobactam; Vincristine

A questionnaire was sent to principal investigators of NIH-sponsored clinical research in sickle cell disease. Twenty of 21 respondents indicated they used parenteral narcotic analgesics for pain episodes sufficiently severe to warrant hospitalization. Eleven used meperidine; seven, morphine; and one each, nalbuphine, hydromorphone, and acetaminophen with codeine. They gave the agents at frequent, regular intervals or by continuous infusion. A total of 41 of more than 3,500 patients required chronic transfusion for pain control. Complications included meperidine-associated convulsions reported by nine respondents and addiction by six. This information indicates that vigorous pain-control methods are used at institutions having a special interest in providing medical care for children with sickle cell disease.

Topics: Acetaminophen; Analgesics; Anemia, Sickle Cell; Child; Child, Preschool; Codeine; Drug Administration Schedule; Drug Combinations; Humans; Hydromorphone; Infant; Length of Stay; Meperidine; Morphine; Nalbuphine; Pain; Pain Management; Seizures

The effects of mu-agonists (morphine, fentanyl) and kappa-agonists (U-50,488, U-69,593, bremazocine, nalbuphine, tifluadom) on the electroconvulsive threshold were studied in mice. The threshold could be significantly elevated by all drugs tested in a dose range that was in the order of magnitude of the antinociceptive ED50. Mice tolerant to the antielectroshock effect of morphine still reacted to U-69,593. The antagonism of the anticonvulsant effect by the mu-antagonist naloxone and the kappa-antagonist MR 2266 was receptor-specific only with fentanyl and U-50,488. The other opioid agonists were either antagonized by both drugs (morphine, U-69,593, bremazocine, nalbuphine) or even by the opposite antagonist (tifluadom). A synergistic effect of mu- and kappa-stimulation is assumed for the mediation of the antielectroshock effect of opioid drugs, but drugs with high affinity and intrinsic activity at one receptor type (fentanyl, U-50,488) are obviously able to bring about their antielectroshock effect through the one respective opioid binding site.

Topics: 3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cyclohexyl)-benzeneacetamide, (trans)-Isomer; Animals; Benzeneacetamides; Benzodiazepines; Benzomorphans; Electroshock; Fentanyl; Male; Mice; Morphinans; Morphine; Nalbuphine; Naloxone; Pyrrolidines; Receptors, Opioid; Receptors, Opioid, kappa; Receptors, Opioid, mu; Seizures