Opioid Induced Rigidity/Parkinsonism

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neurodoc

Neurologist
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I have a Hospice patient (82 yo female w/ metastatic AdenoCa of the lung) who has developed appendicular and axial rigidity along with hoarshness/hypophonia. She has no prior Hx of PD, and the Sx developed shortly after she was prescribed a fentanyl patch
(100mcg/hr, increased from 50mcg/hr). She has also become stuporous. Her PCP had prescibed Marinol and Ativan, but these were d/c'd.

I know that opiates/opioids have been associated with muscular rigidity, but theliterature is far from clear about this or what should be done about it. Any comments?:oops:

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I have a Hospice patient (82 yo female w/ metastatic AdenoCa of the lung) who has developed appendicular and axial rigidity along with hoarshness/hypophonia. She has no prior Hx of PD, and the Sx developed shortly after she was prescribed a fentanyl patch
(100mcg/hr, increased from 50mcg/hr). She has also become stuporous. Her PCP had prescibed Marinol and Ativan, but these were d/c'd.

I know that opiates/opioids have been associated with muscular rigidity, but theliterature is far from clear about this or what should be done about it. Any comments?:oops:

Hmm. 82 y/o frail and debilitated with patch doubled from 50 to 100, now rigid and stuporous. Could it be rigor mortis from doubling the patch. Drop to 75 and wait 3 days. Whats the breakthrough med ?
 
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Fentanyl is notorious for inducing rigidity in anesthesiology. I have seen patients unable to be ventilated after IV fentanyl, it can cause spasm released only by muscle relaxants
 
Fentanyl is notorious for inducing rigidity in anesthesiology. I have seen patients unable to be ventilated after IV fentanyl, it can cause spasm released only by muscle relaxants

my understanding was that only occurs if fentanyl is push fast IV. anyone seen this from other modes of delivery?
 
No -but lets just reason-if IV push causes dramatic spasm then transdermal should be able to produce a lessor degree of spasm -right? One thing that I have learned in 20 + years, don't ever say "that does not happen" esp if "that has never been published" other tidbits -never think that you know everything or you will be humbled on a regular basis and - God made every human being different-and never confuse yourself with God. That son, are my words of wisdom for this morning :)
 
May be opioid induced myoclonus , only thing to do is change or decrease opioids. We see this more commonly in intrathecal opioid patients.
 
I have a Hospice patient (82 yo female w/ metastatic AdenoCa of the lung) who has developed appendicular and axial rigidity along with hoarshness/hypophonia. She has no prior Hx of PD, and the Sx developed shortly after she was prescribed a fentanyl patch
(100mcg/hr, increased from 50mcg/hr). She has also become stuporous. Her PCP had prescibed Marinol and Ativan, but these were d/c'd.

I know that opiates/opioids have been associated with muscular rigidity, but theliterature is far from clear about this or what should be done about it. Any comments?:oops:

I agree with Ligament; this sounds very much like opioid toxicity / myoclonus and not parkinsonism.

Some refs:

http://www.sciencedirect.com/science/article/pii/S0304395997000900

http://www.mcw.edu/FileLibrary/User/jrehm/Case13.pdf
 
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