Central anticholinergic syndrome (CAS) presents with central and/or peripheral neurological symptoms after exposure to anticholinergic medication. Pain management is a challenge for patients who have CAS and concurrent cancer-related pain. We present a patient who became lethargic and unresponsive after receiving butorphanol, with persistent symptoms despite administration of an opioid antagonist. This case report is the first to suggest a causal relationship between opioids and CAS without the presence of confounding anticholinergic medications. CAS should be considered for patients who develop neurological symptoms after opioid exposure and have an incomplete response to an opioid antagonist.
Key words: central anticholinergic syndrome, butorphanol, opioids, cancer-related pain, anticholinergic toxicity, case report
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