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Language: search.filters.language.EnglishSubject: search.filters.subject.methadone

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    Opioid overdose or other somatic comorbidity - fatal case
    (Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2024-04)
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    Bekjarovski, Niko
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    The aim of this case presentation is to emphasize the diagnostic challenges that the clinicians encounter when dealing with a comatose patient and the importance of keeping a broad differential diagnostic panel in mind. Case report: A 47-year-old female patient, was brought by ambulance to the University Clinic for Toxicology in Skopje. On admission, she was comatose (GCS=5), with miotic isochoric pupils, blood pressure was 90/60 mmHg, with oxygen saturation from 85 up to 92%. Тhe obtained data from family indicated that the patient was with opioid use disorder on methadone maintenance therapy. Recently, the patient has consumed large amounts of alcohol . Тhe family's suspicion was that perhaps the new condition was caused by excessive intake of alcohol or methadone or both. In the meantime, the result of alcoholemia showed 67.0 mg/dL (value <100mg/dLlow level) and the toxicological screening in urine sample for tetrahydrocannabinol, opiates, tramadol, amphetamine, 3,4-methylenedioxy-methamphetamine, cocaine, benzodiazepines, buprenorphine was negative with mildly elevated methadone values (the patient was on methadone substitute the last 7 years). Second day on physical examination a brisk response to deep tendon reflexes of the left side of the body with apparent right hemiplegia was noted. Computed tomography of the brain was performed immediately and showed an ischemic stroke with a compressive effect on the left lateral chamber. Although it was immediately started with an aggressive treatment, after 11 days the condition of the patient deteriorated and resulted in death. Conclusion: The notable opioid prevalence, mandates that physicians maintain a high index of suspicion when dealing with a comatose patient, especially if the patient has any known history of opioid abuse. Healthcare professionals should be aware that a comatose state in a patient could be caused by either non-toxicological trigger or by toxic causes.
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    QT PROLONGATION AND VENTRICULAR ARRHYTHMIA IN METHADONE USER PRESENTING WITH SEVERE HYPOKALEMIA
    (Institute of Knowledge Management, 2022-12-16)
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    Mario Jovanoski
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    Elena Grueva Nastevska
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    Hajber Taravari
    Introduction: Severe hypokalemia is a serious, life-threatening condition that can lead to muscle weakness, paralysis, fatigue and different types of cardiac rhythm disturbances including QT prolongation and furthermore lethal arrhythmias. On the other hand, prolongation of the QT interval can be exacerbated in methadone users who receive high doses of the drug. Methadone is a drug that is mostly used as a replacement therapy for opiates, and it is known that it can interfere in the cardiac action potential cycle. Case report: We present a case of 39y/old male who visited our clinic brought by an ambulance due to palpitations, fatigue and muscle weakness in the arms and legs. The patients’ symptoms aggravated in the past 2 weeks when he lost the ability to do the everyday activities and finally to walk, because of extreme weakness of the extremities. On the day of the admission, he experienced a syncope for the first time in his life. His initial ECG revealed sinus rhythm with prolonged QT interval and polymorphic ventricular extrasystoles, which evolved in nonsustained ventricular tachycardia. His initial laboratory finding showed severe hypokalemia, and his previous medical history revealed use of methadone replacement therapy for approximately 20 years. The patient was closely monitored in the intensive care unit, and potassium replacement therapy was immediately initiated by the use of intravenous potassium infusion. Toxicologist and nephrologist were also included in the treatment in order to reduce the methadone dose and to exclude a secondary cause of severe hypokalemia. The patient’s condition improved after 9 days, when the potassium level was in normal range and the rhythm disturbances completely resolved. Conclusion: This case highlights the importance of timely recognition of severe electrolytic abnormalities that can lead to dangerous arrhythmias. Careful replacement with 24h monitoring and frequent laboratory analysis is required until the potassium level reaches the target range and until the heart rhythm stabilizes. This case also reveals the importance of the significance of the follow up of every drug addict that receives methadone replacement therapy on a primary level, in order to exclude QT prolongation. In these cases, the dose of methadone should be reduced or replaced with another medication, in order to prevent potentially lethal arrhythmias.
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    The neurophysiological correlates of cognitive functions during methadone and buprenorphine maintenance treatment: The ERP study
    (AU-CNS, 2021-12)
    Silvana Markovska-Simoska
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    Nada Pop-Jordanova
    Background. The treatment of opioid dependence with methadone and buprenorphine is equally effective with either of the two drugs, in terms of discontinuation and retention in treatment. Buprenorphine, unlike methadone, is, however, renowned for being a drug that gives a "clear head", which is encouraging for those who are students, or who are, in any case, engaged in intellectual work. Aim. The aim of this study has been to determine if there is a difference in the neurophysiological correlates of cognitive functions in individuals treated with methadone (MMT) versus those treated with buprenorphine (BMT). Methods. The study includes 10 participants belonging to the MMT group and 10 others involved in the BMT group; both these study groups were compared with the control group after matching had been carried out for age and gender. Brain activity was recorded with the QEEG Mitsar system while study participants were performing two neuropsychological tasks. The VCPT and ECPT as modifications of the Go/NoGo paradigm were applied in order to obtain cognitive event-related potentials (ERPs) as indexes of executive functions. Besides the behavioural parameters of test performance, amplitude and latency of CNV, Cue P3, P3 Go, P3NoGo, N2Go and N2 NoGo were explored at Fz, Cz and Pz, reflecting different stages of information processing. Results. The MMT group showed longer latencies of the ERP components, and the BMT participants showed slightly better results than those of the MMT group. Still, most of the parameters did not differ significantly from those of the control group. Behavioural parameters showed significantly higher values for variables in the results for reaction time and the number of errors of omission and commission found in the competing MMT vs BMT groups, as well as the control group. Conclusions. Neurophysiological evidence suggests that methadone and buprenorphine both have positive effects on neurophysiological functions, as fewer abnormalities were found in MMT or BMT patients than in healthy controls. It has been shown that the sensitivity and specificity of detecting drug effects increase significantly when adding neurophysiological measures to task performance.