MacDonald Lisa E, Onsrud Jennifer E, Mullins-Hodgin Rita
Novant Health Forsyth Medical Center, Winston-Salem, North Carolina and Novant Health Kernersville Medical Center, Kernersville, North Carolina.
Pharmacotherapy. 2015 Jul;35(7):e118-21. doi: 10.1002/phar.1605. Epub 2015 Jun 25.
Oxymorphone, a semisynthetic μ-opioid receptor agonist, is the major active metabolite of oxycodone. It is a highly potent narcotic analgesic due to its high lipid solubility, which allows it to readily cross the blood-brain barrier and enter the central nervous system. It is available as both an immediate-release and extended-release (ER) formulation. Oxymorphone can be abused by injection or inhalation of crushed tablets; thus, in 2011, the manufacturer of ER oxymorphone reformulated the drug with crush-resistant technology to deter its misuse and abuse. We describe the case of a previously healthy, 24-year-old male who experienced reproducible acute subjective bilateral temporary hearing loss that occurred after inhalation of oxymorphone. He presented to the emergency department complaining of acute bilateral hearing loss after he reported snorting a crushed oxymorphone ER 30-mg tablet. Emergency department evaluation revealed obvious bilateral hearing loss as well as coincidental aspiration pneumonia. The patient's medical history revealed that he had experienced a similar episode of hearing loss after a previous episode of oxymorphone inhalation. His hearing loss began to improve 3 hours after presentation to the emergency department and was completely resolved by the following day. Use of the Naranjo adverse drug reaction probability scale revealed oxymorphone to be a probable cause of this patient's acute hearing loss (score of 6). The mechanism of action of opioid-associated hearing loss (OAHL) is not completely understood, but it is thought to be due to disturbances within the cochlea, such as cochlear ischemia. To our knowledge, this is only the second published case report of acute reversible hearing loss following oxymorphone inhalation and the first published case report of reproducible OAHL. Since opioid misuse continues to be prevalent despite attempts at reformulations to make the drugs crush resistant, a high degree of clinical suspicion is needed to evaluate and treat patients who present with unique findings after episodes of substance abuse, especially those related to tamper-resistant formulations.
羟吗啡酮是一种半合成的μ-阿片受体激动剂，是羟考酮的主要活性代谢产物。由于其高脂溶性，它是一种高效的麻醉性镇痛药，这使其能够轻易穿过血脑屏障并进入中枢神经系统。它有速释和缓释（ER）两种剂型。羟吗啡酮可通过注射或吸入碾碎的片剂被滥用；因此，2011年，羟吗啡酮缓释制剂的制造商采用了抗碾碎技术重新配制该药物，以防止其被误用和滥用。我们描述了一名24岁、既往健康的男性病例，他在吸入羟吗啡酮后出现了可重现的急性双侧主观性暂时性听力损失。他因吸入碾碎的30毫克羟吗啡酮缓释片后出现急性双侧听力损失而前往急诊科就诊。急诊科评估发现明显的双侧听力损失以及并发的吸入性肺炎。患者的病史显示，他在之前一次吸入羟吗啡酮后也曾经历过类似的听力损失发作。他的听力损失在到急诊科就诊3小时后开始改善，并在第二天完全恢复。使用纳兰霍药物不良反应概率量表显示，羟吗啡酮很可能是该患者急性听力损失的原因（评分为6分）。阿片类药物相关听力损失（OAHL）的作用机制尚未完全明确，但认为是由于耳蜗内的紊乱，如耳蜗缺血所致。据我们所知，这是第二例关于吸入羟吗啡酮后急性可逆性听力损失的发表病例报告，也是第一例关于可重现的OAHL的发表病例报告。尽管进行了重新配制以使药物具有抗碾碎性，但阿片类药物的滥用仍然普遍存在，因此对于在药物滥用发作后出现独特症状的患者，尤其是那些与抗篡改制剂相关的患者，需要高度的临床怀疑来进行评估和治疗。
