Opioid withdrawal: Difference between revisions
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#[[Clonidine]] | #[[Clonidine]] | ||
# | #*Mild opioid withdrawal - 0.1 - 0.3 mg PO | ||
#*5mcg/kg PO (as long as SBP >90) | #*5mcg/kg PO (as long as SBP >90) | ||
#Antihistamines | #Antihistamines |
Revision as of 17:29, 8 March 2016
Background
- Withdrawal can be precipitated with administration of antagonist (e.g. naloxone) or partial agonist (e.g. buprenorphine).
- Symptoms are usually uncomfortable but not life-threatening
- Catecholamine surge during withdrawal may cause a level of hemodynamic instability that may not be tolerated by patients with co-morbid conditions
- life-threatening in neonates
Clinical Presentation
- Onset: within hours of cessation
- Symptoms resemble severe case of influenza
Early symptoms
- Agitation/restlessness
- Anxiety
- Muscle aches
- Increased tearing
- Insomnia
- Runny nose
- Sweating
- Yawning
- Skin-Crawling
- May be tachycardic and/or tachypneic but not necessarily
Late symptoms
- Unlike alcohol or benzo withdrawal, unlikely to have seizures
- Typically normal mental status despite agitation
Onset
- Time to peak and duration of symptoms depends on the half-life of the drug involved.
- Heroin: onset 6-12 hours, peak 36-72 hours, duration 7-10 days
- Methadone: onset 30 hours, peak 72-96 hours, duration 14 days or more
- If naloxone-induced withdrawal, typically symptom duration < 1 hour
Workup
- Normally a clinical diagnosis
- Consider a urine tox
Assessment
- Clinical Opiate Withdrawal Score (COWS)
- Can be used to determine severity
Differential Diagnosis
Treatment
- PO/IV hydration PRN
- Clonidine
- Mild opioid withdrawal - 0.1 - 0.3 mg PO
- 5mcg/kg PO (as long as SBP >90)
- Antihistamines
- Diphenhydramine
- Hydroxyzine 50-100mg PO QID x5d
- Antiemetics
- Antidiarrheals
- Loperamide or Octreotide
- NSAIDS
For select cases:
- Buprenorphine
- Partial agonist, may induce withdrawal in opioid intoxicated patients
- Methadone 10mg IM or 20mg PO
- Consider if withdrawal precipitated by interruption in opioid use, NOT if antagonist (e.g. narcan) was given
See Also
Source
- Tintinalli