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VIKTORIA kHARLAMB, PHARM.D., CDE, is Clinical Pharmacist and Residency Coordinator, Department of Pharmacy, Department of Veterans Affairs New York Harbor Healthcare System (NYHHS), New York, and Clinical Assistant Professor of Pharmacy, Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University (LIU), Brooklyn, NY. HELENKOURLAS, PHARM.D., is Assistant Professor of Pharmacy Practice, Arnold and Marie Schwartz College of Pharmacy and Health Sciences, LIU, and Drug Information Specialist, NYHHS.

Address correspondence to Dr. Kharlamb at the Department of Pharmacy (119), Department of Veterans Affairs New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010 (viktoria.kharlamb{at}va.gov).

Purpose. The case of a patient who developed edema after receiving methadone for chronic low back pain is reported. Summary. A 45-year-old white woman developed edema in her lower extremities one week after starting methadone, etodolac, and gabapentin as part of her treatment for chronic low back pain. She was taking methadone as part of her treatment regimen to manage her pain in addition to other agents, including etodolac and gabapentin. After several days on this therapy, she developed edema and stated that she was "feeling drunk." At that time the etodolac and gabapentin were stopped, and the methadone dosage was increased. Several days later, the patient returned to the pain clinic, complaining of continued swelling. The methadone dosage was then decreased, and a diuretic was added to treat the edema; however, her edema did not resolve with the lower dosage of methadone. Methadone was then discontinued, and a fentanyl patch was prescribed. Prednisone was also prescribed, and the dosage of the diuretic was increased. The patient’s symptoms resolved, and prednisone was ultimately tapered. The likelihood that the administration of methadone was related to the development of edema in this patient was determined to be probable. There have been a few cases reported in the literature regarding the development of edema with methadone use. In the cases reported, the edema developed after three to six months of methadone therapy. Conclusion. A patient with chronic low back pain developed edema one week after receiving methadone as part of her pain management regimen. Index terms: Back pain; Diuretics; Dosage; Edema; Etodolac; Fentanyl; Furosemide; Gabapentin; Methadone; Opiates; Prednisone; Steroids, cortico-; Toxicity

 

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