Associated Mood Changes with Naloxegol Therapy for Opioid-Induced Constipation in a Patient with Psychiatric Disease

Abstract

The objective of this clinical case report is to highlight unusual adverse effects brought on by naloxegol therapy in a patient with underlying psychiatric illness. The patient is a 68-year-old female, with a psychiatric history of bipolar disorder, who presented for chronic pain management and opioid-induced constipation. After failing other therapies, she was trialed on naloxegol on three separate occasions. She experienced mood lability with symptoms including agitation, confusion, irritability, hysteria and unprompted crying spells on each occasion. Notably, the drug manufacturer does not describe mood lability, nor the profound psychiatric manifestations outlined in our case report, as side effects of Naloxegol. Clinicians may consider judicious prescription of naloxegol when treating opioid-induced constipation in patients with pre-existing psychiatric co-morbidities.

Lay abstract

Our case report describes a patient with a history of pre-existing psychiatric illness and chronic pain treated with opioids who experienced unusual psychiatric side effects with naloxegol treatment. Naloxegol is used in patients who suffer from constipation from treatment with long-term opioids, often after not responding to the first-line treatment, which is stool-softeners and laxatives. Our patient, a 68-year-old female with bipolar disorder, tried naloxegol multiple times and each time experienced side effects that resolved after stopping the medication. Her symptoms included agitation, confusion, irritability, hysteria and unprompted crying spells. The drug manufacturer states that the most common side effects are gastrointestinal, such as diarrhea and nausea, but does not mention these types of psychiatric symptoms as possible side effects.

Keywords::

• analgesia
• anesthesia
• chronic pain
• Naloxegol
• opioid-induced constipation
• opioids
• pain
• pain management
• pharmacology
• psychology

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Informed consent disclosure

The authors state that they have obtained verbal and written informed consent from the patient/patients for the inclusion of their medical and treatment history within this case report.