N-ALLYLNORMORPHINE IN TREATMENT OF DIHYDROMORPHINONE AND METHORPHINAN OVERDOSAGE

Abstract

We have had the singular opportunity of treating the effects of overdosages of dihydromorphinone (dilaudid®) hydrochloride and methorphinan (dromoran®) hydrobromide in the same patient by injection of N-allylnormorphine ("nalline") hydrochloride. Clinical reports of treatment of poisoning by morphine and meperidine hydrochloride¹ and methadone hydrochloride² in man and reports of antagonism of respiratory depression caused by dihydromorphinone and other narcotics in laboratory animals have appeared in the literature.³ We believe this to be the first instance in which N-allylnormorphine has been used to antagonize the depressant effects of methorphinan and the first clinical instance of its use in dihydromorphinone overdosage, and we feel, therefore, that this case should be of general interest. REPORT OF CASE The patient, a thin, chronically ill 60-year-old man, weight 107 lb. (48.5 kg.), was admitted for drainage of an empyema and bronchopleural fistula that followed pneumonectomy and thoracoplasty for long-standing suppurative disease of