Departments of Obstetrics and Gynecology and Psychiatry, Boston University School of Medicine, and the Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts.
Obstet Gynecol. 2020 Nov;136(5):905-907. doi: 10.1097/AOG.0000000000004106.
We report a case of delayed norfentanyl clearance in a 33-year-old pregnant woman. Norfentanyl is the major metabolite of fentanyl.
A multigravid woman with opioid use disorder presented at 7 weeks of gestation for treatment. Despite opioid abstinence, her urine was positive for norfentanyl on 10 distinct gas chromatography-mass spectrometry urine screens. The results demonstrated a steady decrease of norfentanyl over the course of 70 days after her last fentanyl usage, far exceeding expected rates of fentanyl clearance.
This case highlights the importance of acknowledging pregnancy, genetic, or medication-induced changes to fentanyl pharmacokinetics when interpreting urine tests, especially given the potential sequelae of a false-positive urine test result.
我们报告了一例 33 岁孕妇中出现的延迟去甲芬太尼清除现象。去甲芬太尼是芬太尼的主要代谢物。
一位多胎孕妇，患有阿片类药物使用障碍，在妊娠 7 周时因治疗而就诊。尽管她已经停止使用阿片类药物，但她的尿液在 10 次不同的气相色谱-质谱尿液筛查中均呈去甲芬太尼阳性。结果表明，在她最后一次使用芬太尼后的 70 天内，去甲芬太尼的水平持续下降，远远超过预期的芬太尼清除率。
本案例强调了在解释尿液检测结果时，应考虑到怀孕、遗传或药物引起的芬太尼药代动力学变化的重要性，尤其是考虑到假阳性尿液检测结果可能产生的潜在后果。
