A patient with fever and delirium while wearing a fentanyl transdermal therapeutic system (TTS) showed marked improvement following intravenous naloxone hydrochloride administration

Abstract

A 60-year-old man became febrile and delirious following treatment with a fentanyl transdermal therapeutic system, but he showed marked improvement after intravenous naloxone hydrochloride (0.2 mg) administration. He had a 34-year history of hemodialysis and general pain due to dialysis amyloidosis. When he became delirious (Japan coma scale: JCS, 10–20), he had decreased blood pressure (systolic blood pressure: 60–70 mmHg) and fewer breaths (10/minute), but his condition showed immediate and marked improvement after intervention. Fentanyl blood levels were lower than those that caused the respiratory depression (2 ng/ml).