Hanes S D, Franklin M, Kuhl D A, Headley A S
Department of Clinical Pharmacy, University of Tennessee, Memphis 38163, USA.
Pharmacotherapy. 1999 Jul;19(7):897-901. doi: 10.1592/phco.19.10.897.31557.
Respiratory depression secondary to morphine intoxication occurred in an elderly patient with chronic renal failure (CRF). It was reversed with a continuous infusion of naloxone. Approximately 11 hours after the infusion was discontinued, the patient relapsed into respiratory depression consistent with opioid intoxication. He was rechallenged with a naloxone infusion with resolution of the opioid effects. This case suggests prolonged antagonism of opioid effects inconsistent with naloxone's reported pharmacologic effects. Serum naloxone concentrations measured after the end of the infusion suggest that the drug's pharmacokinetics were significantly altered. Further research is necessary to characterize pharmacokinetic changes that occur in CRF. In the absence of this information, similar patients should be closely monitored for relapse of respiratory depression after naloxone is discontinued.
一名患有慢性肾衰竭（CRF）的老年患者因吗啡中毒继发呼吸抑制。通过持续输注纳洛酮使其得到逆转。在输注停止约11小时后，患者再次出现与阿片类药物中毒相符的呼吸抑制。再次给予纳洛酮输注后阿片类药物作用得到缓解。该病例提示阿片类药物作用的拮抗时间延长，这与纳洛酮所报道的药理作用不一致。输注结束后测得的血清纳洛酮浓度提示该药物的药代动力学发生了显著改变。有必要进行进一步研究以明确慢性肾衰竭时发生的药代动力学变化。在缺乏此类信息的情况下，对于类似患者，在停用纳洛酮后应密切监测呼吸抑制是否复发。
