Pentazocine‐induced ulcers revisited

Sethi, Sumit; Sarkar, Rashmi; Garg, Vijay Kumar; Khurana, Nita

doi:10.1111/ijd.13002

Cited by 7 publications

(2 citation statements)

References 12 publications

(36 reference statements)

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“…Our findings carry important clinical and public health implications. Considering that xylazine is a full κOR agonist, we note two prominent historical and international examples of nonmedical use of the κOR agonist pentazocine: the "Ts and Blues" (pentazocine and tripelennamine) outbreak in the midwestern United States from 1977 to 1981 (75-77), and pentazocine injection in Nigeria (78) and India (79)(80)(81)(82). In both settings, characteristic skin lesions beyond the site of injection, eschar formation, and wound cratering were observed (83)(84)(85)(86), with morphological similarity (61) to reports involving xylazine from Puerto Rico (62), the Philadelphia area (16,(63)(64)(65)(66), and New Haven, Connecticut (67).…”

Section: Discussionmentioning

confidence: 99%

Xylazine is an agonist at kappa opioid receptors and exhibits sex-specific responses to naloxone administration

Bedard,

Murray,

Huang

et al. 2023

Preprint

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Xylazine has been found in the unregulated drug supply at increasing rates, usually in combination with fentanyl. It has become critical to understand its basic pharmacology, how it impacts behavior, and how it interacts with fentanyl in rodent models of opioid administration. Despite commentary from scientists, politicians, and public health officials, it is not known if xylazine impacts the efficacy of naloxone, the opioid receptor antagonist used to reverse opioid induced respiratory depression. Furthermore, few studies have examined the effects of xylazine alone, without co-administration of ketamine. Here, we examine the impact of xylazine alone and in combination with fentanyl on several key behaviors in male and female mice. We demonstrate differential locomotor responses by dose and sex to xylazine. Surprisingly, our results further indicate that naloxone precipitates withdrawal from xylazine and a fentanyl/xylazine combination, in both sexes, with enhanced sensitivity in females. Further, we show that xylazine is a full agonist at the kappa opioid receptor, a potential mechanism for its naloxone sensitivity.One-Sentence SummaryWe present surprising new insights into xylazine and fentanyl pharmacology with immediate implications for clinical practice and frontline public health.

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Section: Discussionmentioning

confidence: 99%

Xylazine is an agonist at kappa opioid receptors and exhibits sex-specific responses to naloxone administration

Bedard,

Murray,

Huang

et al. 2023

Preprint

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“…[11] Various mechanisms proposed for the cutaneous side effects of pentazocine include trauma of repeated injections, vasoconstriction with tissue ischemia at injection sites, and inflammatory response to precipitated pentazocine in tissues although the exact mechanism remains unknown. [612]…”

Section: Discussionmentioning

confidence: 99%

Local complications of pentazocine abuse: Case report and review

Kumar¹,

Soren

Simlai

et al. 2018

Ind Psychiatry J

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The skin is the tissue most commonly affected by intravenous drug addiction with pentazocine. The present article attempts to review the adverse effects of injecting drug use along with one case report of cutaneous complications of injection pentazocine abuse underlining the need for early identification, management, and above all prevention. It also provides credence to the fact that pentazocine abuse is common in paramedical staff, and easy accessibility of pentazocine injection can easily lead to serious complications.

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Pentazocine

2016

Reactions Weekly

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S Pentazocine Ulcers: case reportA 45-year-old woman developed ulcers [duration of treatment to reaction onset not stated] during treatment with pentazocine [dose and route not stated].The woman presented with a 2 year history of multiple ulcerative lesions and scars distributed all over the body. She had been receiving pentazocine for chronic headache. Initially, she had started pentazocine once per week, but over the 2 year period the dose was gradually increased to three times per day. After each injection, the site of injection became red and swollen and gradually turned black. Later, her skin eventually sloughed off, discharging blood stained or oily fluid and leaving a raw area. Her clinical examination revealed ulcers on the bilateral hands, arms, thighs and trunk. Some of the ulcers showed a clean floor covered with granulation tissue; others had yellowish slough and crusting. Small ulcers were present at the sites of venous access on the dorsum of the hands, along with fibrosis and hyperpigmentation. Later, her history of pentazocine abuse and the characteristic clinical findings suggested a diagnosis of drug culpability. A deep scalpel biopsy revealed edema and a lymphohistiocytic infiltrate in the upper dermis and fibrosis in the mid-dermis. She was referred to the psychiatric department and diagnosed with a behavioural disorder caused by opioid dependence.The woman was treated with daily dressing with framycetin and paraffin gauze, and most of them healed within a month.Author comment: "We describe a case of pentazocine induced ulceration and fibrous myopathy of two years in duration and give a brief review of the various mechanisms postulated to explain these adverse effects". Sethi S, et al. Pentazocine-induced ulcers revisited.

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Pentazocine‐induced ulcers revisited

Cited by 7 publications

References 12 publications

Xylazine is an agonist at kappa opioid receptors and exhibits sex-specific responses to naloxone administration

Xylazine is an agonist at kappa opioid receptors and exhibits sex-specific responses to naloxone administration

Local complications of pentazocine abuse: Case report and review

Pentazocine

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