Severe Opioid Withdrawal Precipitated by a Medication Containing Samidorphan

What is it about?

Samidorphan is a newer medication currently marketed in combination with olanzapine to mitigate weight gain associated with antipsychotics. However, it also has greater affinity for the μ-opioid receptor than buprenorphine and hydromorphone, introducing the risk of serious interactions between these medications. Despite a package insert warning of this interaction, cases of severe and treatment-resistant opioid withdrawal have occurred, as further illustrated by this case.

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Photo by James Yarema on Unsplash

Photo by James Yarema on Unsplash

Why is it important?

In this era of increased interest in both improving opioid stewardship and our management of psychiatric illnesses, prescribing safety must expand to include new and emerging medications and formulations that may have unintended and potentially serious interactions. Samidorphan is a newer medication, and prescribers may not be fully aware of its potency and potential for serious drug interactions. As such, clinicians who may want to prescribe therapies that contain this medication should be aware of its risks and be sure to explicitly screen patients for use of opioids and opioid replacement therapies beforehand.