SHM Converge Scientific Abstract ePoster Gallery-Opioid Therapy Reassessed: Methadone-Induced Hypoglycemia and a Transition to Buprenorphine

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This case report describes methadone-induced hypoglycemia and a successful transition from methadone to buprenorphine using a microdosing protocol. Opioids can affect endocrine function, including suppression of the hypothalamic-pituitary-adrenal axis, and methadone in particular has been linked to lower blood glucose levels, especially at doses above 40 mg.<br /><br />The patient was a 66-year-old man with end-stage renal disease on dialysis, hypertension, opioid use disorder treated with 135 mg methadone, and a history of hepatitis C. He presented with bilateral leg ulcerations, complex pain, and severe hypoglycemia (blood glucose 35 mg/dL), initially thought to be related to renal failure. However, hypoglycemia persisted despite dextrose and dialysis, and chart review showed recurrent episodes dating back to 2022. Workup for insulinoma and other causes was negative, including normal c-peptide and proinsulin levels, negative sulfonylurea testing, and unremarkable MRI and CT imaging.<br /><br />Because methadone was suspected as the cause, the patient was switched to buprenorphine using a three-day microdose induction. On the final day, after methadone was fully stopped, he developed precipitated opioid withdrawal with symptoms including dry mouth, yawning, rhinorrhea, nausea, and sweating. He was treated with 24 mg buprenorphine plus supportive medications, and the withdrawal resolved.<br /><br />Following conversion to buprenorphine, his hypoglycemic episodes became rare and rarely required dextrose. The authors emphasize that methadone should be considered in the differential diagnosis of unexplained hypoglycemia, especially in patients on higher doses. They also note that buprenorphine microinduction can reduce withdrawal risk but still may require close inpatient monitoring and rapid dose adjustment if precipitated withdrawal occurs.

Asset Subtitle

Nicole M. Leonick

Meta Tag

Author List Darve Robinson, Nicole M. Leonick

Category Clinical Vignettes

Concept Methadone

Concept Hypoglycemia

Concept Buprenorphine

Concept Buprenorphine-precipitated Opioid Withdrawal

Concept Microdosing

Distinguished Non-Finalist

Presenter Organization Cooper Medical School of Rowan University

Presenting Author Nicole M. Leonick

Track Adult

Keywords

methadone-induced hypoglycemia

buprenorphine microdosing

opioid use disorder

end-stage renal disease

precipitated opioid withdrawal

blood glucose

methadone to buprenorphine transition

endocrine effects of opioids

dialysis patient

case report

Methadone

Hypoglycemia

Buprenorphine

Buprenorphine-precipitated Opioid Withdrawal

Microdosing