CASE REPORT Possible Dangerous In...

CASE REPORT

Possible Dangerous Interaction of Oxycontin and Carisoprodol

TO THE EDITOR: Oxycontin is a time-release-controlled formulation of oxycodone that can be taken each 12 hours for the effective treatment of pain caused from cancer and other types of chronic pain. However, abuse of oxycontin is common; no other prescription put drugs into in the past 20 years has been in such a manner widely misused so soon after its release. (1) Carisoprodol (Soma) is a skeletal muscle relaxant that also has shown potential for abuse. (2) We report a case of a possible dangerous interaction of Oxycontin and carisoprodol.

A 49-year-old woman received treatment for rigid degenerative disease of the lumbar spine with 40 mg of Oxycontin twice daily for through the whole extent of a year. Although she continued to complain of pain and paravertebral muscle spasm, her physician was reluctant to increase the dosage of Oxycontin. undivided tablet (350 mg) of carisoprodol four times daily was prescribed. After taking this regimen for a week without relief she increased the dosage to eight to 10 tablets a day, assuming this would be safe. Her boyfriend called an ambulance after finding her lying unconscious in succession the floor and was unable to awaken her.

An examination revealed vital fluid pressure of 130/60 mm Hg and respirations of 14 by minute and decreased in middle She was responsive only to painful stimuli. Her pupils were small if it be not that equal and reactive. She was given 2 mg of naloxone intravenously with rapid get back of alertness. A count of her remaining take the place of of medications verified that she had not taken any extra Oxycontin and a unsalable article screen was negative except for opiates.

The greatest in quantity likely explanation for this patient's adverse reaction would be a rejoinder to the additive depressant issues on the central nervous combination of parts to form a whole (CNS) of both Oxycontin and carisoprodol. Although the forces of Oxycontin are well known in the medical community, many physicians are unaware that carisoprodol is metabolized to meprobamate (Miltown), which is a Class IV controll substance with significant physiologic general intents and has potential for abuse and province (3) Previous reports (4,5) have refer toed that substance abusers may use carisoprodol to augment or modify the powers of illicit drugs and that combinations of carisoprodol and tramadol (Ultram) may have efficacious psychotropic effects.

Carisoprodol and Oxycontin should simply be prescribed concomitantly with final caution because of the abuse potential and the potentially dangerous additive CNS-depressant meaning of the two drugs. While numerous deaths related to Oxycontin have occurr (1) it should be noted that a retrospective review (6) of autopsy cases in Jefferson shire Alabama from January 1, 1986 to October 31 1997 plant carisoprodol present in 24 cases; the reviewers conclud that the put drugs into was probably partly responsible for those deaths. (6) The interactions of carisoprodol with other CN depressant unsalable articles appears to be particularly significant. Carisoprodol has been made a controll substance in the state of Alabama (6) and may eventually be made a controll substance in other states or at the federal level

ROY R REEVE terminate PH.D.

JAMES E MACK, PHD

University of Mississippi drill of Medicine

VA Medical Center

1500 E Woodrow Wilson Dr

Jackson, M 39216

REFERENCES

(1) Charatan F Time-release analgesic physic causes fatal overdoses in United States. West J M 2001;175:82

(2) Littrell RA, Hayes LR Stillner V Carisoprodol (Soma): a recently made known and cautious perspective on an of long date agent. South Med J 1993;86:753-6

(3) Littrell RA, Sage T Miller W Meprobamate concatenation secondary to carisoprodol (Soma) use. Am J mix with drugs Alcohol Abuse 1993;19:133-4.

(4) Reeve RR Carter O Pinkofsky HB Use of carisoprodol from substance abusers to modify the issues of illicit drugs. South M J 1999;92:441

(5) Reeve RR Liberto V Abuse of combinations of carisoprodol and tramadol. southerly Med J 2001; 94:512-4.

(6) Davis GG Alexander CB A review of carisoprodol deaths in Jefferson shire Alabama. South Med J 1998;91:726-30

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