Toxicology

Opioid Toxidrome

TROpioid Toksidromu
Also known as:Opioid intoxication · Opioid toxicity

A clinical syndrome of opioid excess, mediated mainly by mu-opioid receptor agonism and defined by the triad of depressed consciousness, respiratory depression (reduced rate and/or depth) and miosis.

In depth

Respiratory depression, the main cause of death, reflects a blunted brainstem response to carbon dioxide; hypotension, bradycardia, hypothermia and non-cardiogenic pulmonary oedema may accompany it. Miosis may be absent with co-ingested sympathomimetics or anticholinergics, hypoxic brain injury or pethidine; tramadol and pethidine can cause seizures, and methadone QT prolongation. Toxicity may arise at usual doses with codeine or tramadol in CYP2D6 ultrarapid metabolizers, or from morphine metabolites accumulating in renal failure.

Management prioritises airway and bag-valve-mask ventilation, then the competitive antagonist naloxone titrated to adequate spontaneous breathing rather than full arousal, to avoid precipitating withdrawal. As naloxone often acts more briefly than the opioid, notably methadone or modified-release products, prolonged observation or infusion may be needed.

Clinical pearl

Pulse oximetry can stay normal in a patient on supplemental oxygen despite marked hypoventilation and hypercapnia; respiratory rate, sedation level and, where available, capnography are more reliable monitors of opioid-induced respiratory depression.

Example drugs

Morphine Oxycodone Fentanyl Methadone Tramadol Codeine
TRIn Turkish

Opioid Toksidromu

Başlıca mü opioid reseptör agonizmasının aracılık ettiği, bilinç bozukluğu, solunum depresyonu (hız ve/veya derinlikte azalma) ve miyozisten oluşan triadla tanımlanan opioid fazlalığı sendromudur.

Başlıca ölüm nedeni olan solunum depresyonu, beyin sapının CO₂'ye yanıtının azalmasından kaynaklanır; hipotansiyon, bradikardi, hipotermi ve kardiyojenik olmayan akciğer ödemi eşlik edebilir. Sempatomimetik veya antikolinerjik ilaçlarla birlikte alımda, hipoksik beyin hasarında ya da petidin alımında miyozis görülmeyebilir; tramadol ve petidin nöbete, metadon QT uzamasına yol açabilir. CYP2D6 ultra hızlı metabolizörlerde kodein veya tramadolle, böbrek yetmezliğinde biriken morfin metabolitleriyle olağan dozlarda da toksisite görülebilir.

Tedavide öncelik havayolu ve balon-valf-maske ventilasyonudur; ardından yarışmalı antagonist nalokson, yoksunluğu tetiklememek için tam uyanıklığa değil yeterli spontan solunuma göre titre edilir. Naloksonun etkisi, özellikle metadon ve değiştirilmiş salımlı ürünlerde, opioidinkinden sıklıkla kısa sürdüğünden uzun gözlem veya infüzyon gerekebilir.

Ek oksijen alan hastada belirgin hipoventilasyon ve hiperkapniye karşın nabız oksimetrisi normal kalabilir; opioide bağlı solunum depresyonunun izleminde solunum hızı, sedasyon düzeyi ve olanak varsa kapnografi daha güvenilirdir.

Diğer adları:Opioid zehirlenmesi · Opioid intoksikasyonu
Updated 24.09.2026 0 views Educational reference — verify against current sources before clinical use.

Read next

ToxidromeToksidrom

A constellation of signs and symptoms (vital signs, mental status, pupils, skin and bowel sounds) characteristic of poisoning by a particular class of agents, used to identify the likely cause at the bedside.

 AntidoteAntidot

A substance that counteracts the effects of a poison or drug overdose by preventing its absorption, binding or inactivating it, antagonising it at its site of action, enhancing its elimination or reversing its toxic effects.

 Competitive AntagonismYarışmalı Antagonizma

Reversible antagonism in which the antagonist binds to the same site as the agonist, so the block can be overcome by raising the agonist concentration; the agonist curve shifts to the right in parallel without a fall in maximal response.

 Ultrarapid MetabolizerUltra Hızlı Metabolizör

A CPIC phenotype for a person with increased drug-metabolising enzyme activity, often from a gene duplication or an increased-function allele, above the normal metabolizer range.

 CYP2D6CYP2D6

A highly polymorphic cytochrome P450 enzyme that metabolises a large number of drugs, including several opioids and antidepressants, and activates key prodrugs.

 Withdrawal SyndromeYoksunluk Sendromu

A characteristic cluster of signs and symptoms that follows abrupt discontinuation, rapid dose reduction or antagonist reversal of a drug to which the body has adapted during prolonged use.