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Male with CYP2D6 positive and withdrawal to fentanyl

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43 yr Male. CYP2D6 levels are 5% making 1/3 of drugs unusable. July 8, spider bite weakens vein, venous pooling starts, leg is in pain. I'm immune to all pain meds except ones that hit a certain receptor (Stadol and Fentanyl). Prescribed 400mcg Actiq, max 4 per day for two months until leg healed. Never misused it. Leg healed 7 days ago, so I stopped Actiq. Day 1-3, no problem. Day 4: Sinus Tachychardia at 120-130. Lightheaded. EKG, chest X-ray, blood work up, all perfect. My doc is on vacation. Only daily med is Vyvanse 70mg bid.
Current issues: Severe fatigue, pulse at 90 (66 is normal), and it hurts to eat (mid-lower bilateral pressure dull pain).
Question: How do I end this as fast as possible? I'm supposed to fly to Jordan on Monday.
Exercise? Rest? Fluids? (What type?). Supplements? Diet? Basket weaving? :). Thanks doc.

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
 31 Doctors Online


Hello,

Thank you for asking your query at DoctorSpring.

I assume that nothing unusual has happened within the span of last 7 days, after stopping Actiq (like Fever, infections at the wound site etc).
If that is the case the symptom patter you are experiencing from Day 4 of stoppage of Actiq is most probably an opioid withdrawal reaction. Physical dependence can occur even within 3 weeks of opioid intake. Even though the symptoms are not very typical of opioid withdrawal, it is suggestive. (Typical symptoms might not be present in all the cases). I acknowledge the fact that Actiq is short acting, but withdrawal symptoms can manifest late. A normal blood work and ECG rules out other possibilities. You have stopped the drug rather suddenly.

Well, how do you end this ? - If this is really troubling you do not hesitate to visit ER or get medical help. You may need drug treatment of the withdrawal (which will include long acting opioids or partial opioid antagonists) . Observation is recommended only if you are comfortable and if your symptoms are resolving. Do no exercise or over exert. Take rest (Basket making is fine though !:). Drink plenty of water. Normal diet will do. You can expect gradual improvement over 2-4 days.

Hope this helps
Please feel free to ask followup questions.
Thank you


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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