Metabolism - Clinical and Experimental
Volume 46, Issue 2 , Pages 130-134, February 1997

Hypothalamic-pituitary-adrenal axis hypersensitivity to naloxone in opioid dependence: A case of naloxone-induced withdrawal☆

  • Joan A. Culpepper-Morgan

      Affiliations

    • Corresponding Author InformationAddress reprint requests to Joan A. Culpepper-Morgan, MD, c/o The Biology of Addictive Diseases Laboratory, The Rockefeller University, 1230 York Ave, New York, NY 10021.
    • ,
  • Mary Jeanne Kreek

The Biology of Addictive Diseases Laboratory, The Rockefeller University, New York, NY, USA

Received 23 June 1995; accepted 5 August 1996.

Abstract 

A case of opioid withdrawal precipitated in an opioid-dependent person by low plasma levels of naloxone is presented. In this patient, changes were observed in the hypothalamic-pituitary-adrenal (HPA) axis that preceded the clinical symptoms and adrenergic signs of withdrawal. Plasma naloxone levels were strongly correlated with plasma cortisol levels (P < .0001, R2 = .73, r = .85). In addition, these neuroendocrine changes persisted after adrenergic changes and clinical symptoms had been ameliorated by administration of a short-acting opioid agonist. It is suggested that the HPA axis is a more sensitive indicator of opioid withdrawal than the adrenergic system.

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☆ Supported by Center Grant No. DA-P50-05130 and Research Scientist Award No. DA-K05-00049 to M.J.K. from the Alcohol Drug Abuse and Mental Health Association (Bethesda, MD), and General Clinical Research Center Grant No. MO1-RR0102 from the National Institutes of Health (Bethesda, MD) to The Rockefeller University Hospital.

PII: S0026-0495(97)90289-4

Metabolism - Clinical and Experimental
Volume 46, Issue 2 , Pages 130-134, February 1997

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