Presented at the 2013 AAPM Annual Meeting « Back

Oxymorphone-ER for the Treatment of Interferon-Induced Rigors in a Malignant Melanoma Patient

Lindsay N. Shroyer, MD, lshroyer@health.usf.edu¹, Rafael Miguel, MD¹, (1) University of South Florida, Tampa, Florida

Introduction: Rigors are believed to occur from thermoregulatory response to hypothermia or muscle hyperactivity with clonic or tonic patterns and can be seen after interferon therapy.1 Clonidine, meperidine, tramadol, and ketamine are frequently used medications demonstrating efficacy in randomized, double-blind, placebo-controlled trials.2 We report the case of a patient who developed severe flu-like symptoms associated with intractable rigors interfering with activities of daily life, primarily treated with oxymorphone-ER. Report of case: A 29-year-old patient with a diagnosis of malignant melanoma of the left thigh underwent excision and sentinel node biopsy. He was treated with high dose Intron A (interferon alpha 2b) therapy for 20 planned doses. The patient reported diffuse body pain, during and after the treatment, described as aching, burning, shooting, and stabbing. The patient was initially treated with hydromorphone for his rigors and pain, with no improvement. Subsequent treatment with meperidine and tapentadol-ER also failed to improve his rigors. After treatment of oxymorphone-ER 7.5 mg, once nightly initially and ultimately titrated to three times daily, the patient’s rigors improved dramatically at 1, 2, 3, and 5 month evaluations. Conclusion: This case demonstrated improvement of rigors with oxymorphone-ER 7.5 mg PO q 8 hours. To our knowledge, this is the first report of the use of oxymorphone- ER in the treatment of interferon induced rigors. Our experience suggests that it may be reasonable alternative to meperidine, especially if meperidine is contraindicated as in the case of renal dysfunction, toxic psychoses or concomitant use of MAOI.3 References: 1) Sessler DI. Temperature monitoring. In: Miller RD, Anesthesia 4th ed. New York, NY: Churchill Livingstone, 1994; 1363-82. 2) Park SM, Mangat HS, Berger K, Rosengart AJ. Efficacy spectrum of antishivering medications: Meta-analysis of randomized controlled trials. Critical Care Medicine 2012 Vol 40, No 11: 1-13. 3) Azari LM, Sheehan VS, Sachdev JC, Jones TS. Dantrolene Sodium for the Treatment of Aldesleukin-Induced Rigors in a Melanoma Patient. The Annals of Pharmacotherapy. 2012 Vol 46; 324-57. 4) Craig DS. Oxymorphone Extended-Release Tablets (Opana ER) For the Management of Chronic Pain. P&T 2010 Vol 35 No 6.

Funding: None