www.ijbcp.com International Journal of Basic & Clinical Pharmacology | February 2019 | Vol 8 | Issue 2 Page 346 IJBCP International Journal of Basic & Clinical Pharmacology Print ISSN: 2319-2003 | Online ISSN: 2279-0780 Case Report A case of idiopathic edema after opioid abuse cessation: can failed aldosterone escape be implicated? Ashutosh Ratnam 1 *, V. K. Sashindran 2 , Anup Kanwar 2 INTRODUCTION A considerable quantum of data suggests that the use of opioid drugs is associated with peripheral edema regardless of the means of delivery or of the specifics of the opioid used, be it oral methadone, transdermal fentanyl or epidural morphine. 1-3 Unfortunately, the means by which opioids as a collective appear to cause edema is still poorly understood. A number of hypotheses attempting to explain the phenomenon already exist - opioids have been conjectured to induce Anti-diuretic Hormone release, to produce Histamine mediated changes in tissue permeability and to exacerbate pre-existing vascular pathology. However, most reports of opioid-associated edema describe heavy ongoing opioid use, in which context any of the above hypotheses can stand valid. Authors present a case of edema instead emerging in a patient as a late complication after cessation of abuse. Our SaWLeQWｶV cOLQLcaO SUeVeQWaWLRQ, dLVeaVe WUaMecWRU\ aQd almost therapeutic response to Spironolactone implicate failed aldosterone escape as a possible mechanism for opioid-abuse related edema. CASE REPORT A 39 year old female nursing home attendant who had been abusing the prescription opioid Pentazocine on a daily basis for the preceding year was brought to the outpatient psychiatric treatment center. She had been stealing ampoules of the injectable lactate form of the drug fURP Whe QXUVLQg hRPe Vhe ZaV ZRUNLQg LQ, aQd ZaV ｵVNLQ- SRSSLQgｶ LW, LQMecWLQg heUVeOf VXbcXWaQeRXVO\ RYeU SaUWV Rf ABSTRACT Edema is a recognized complication of ongoing heavy opioid use, regardless of the means of delivery or the specifics of the drug in question. The mechanism responsible remains incompletely understood. Hypotheses currently offered include increased Anti-Diuretic Hormone (ADH) secretion, histamine-mediated permeability changes, independent opioid-receptor mediated fluid retention and an exacerbation of pre-existing vascular compromise. Authors report a case of a 39yr old lady in whom edema emerged 7 months after cessation of opioid abuse. All secondary causes of edema were excluded by an exhaustive battery of investigations. The edema failed to recede with loop diuretics, and resolved only on institution of spironolactone, on which she maintained improvement. This case study reinforces hypotheses of ADH likely mediating opioid associated edema and suggests that aldosterone receptor antagonists are probably a superior class of drugs in opioid-associated edema. It also suggests that the physiological changes caused by opioid use that are responsible for edema are likely stable and persist well beyond the period of actual use. Reformed opioid abusers who never received OST are a huge population whose unique physiological status is likely to yield valuable insights into not just the pathology of opioid-abuse related edema, but the pathology of opioid use as a whole. Keywords: Aldosterone, Edema, Opioid analgesics, Opioid-related disorders DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20190159 1 Department of Psychiatry, 2 Department of Medicine, Armed Forces Medical College, Pune, Maharashtra, India Received: 21 November 2018 Accepted: 28 December 2018 *Correspondence to: Dr. Ashutosh Ratnam, Email: ashratnam@yahoo.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open- access article distributed under the terms of the Creative Commons Attribution Non- Commercial License, which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.