Opioid withdrawal: Difference between revisions
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*'''Unlike [[alcohol]] or [[benzodiazepine]] withdrawal, patients rarely have seizures''' | *'''Unlike [[alcohol]] or [[benzodiazepine]] withdrawal, patients rarely have seizures''' | ||
*''Altered mental status is also not part of opiod withdrawal signs''' | *'''Altered mental status is also not part of opiod withdrawal signs''' | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 03:34, 9 March 2016
Background
- Opioid withdrawal can be precipitated with administration of antagonist (e.g. naloxone) or partial agonist (e.g. buprenorphine). [1] or as a result of cessation of use.
- Symptoms are usually uncomfortable but not life-threatening and manifest with agitation and restlessness but does not cause altered mental status
- Symptoms may resemble that of Influenza [2]
- Catecholamine surge during withdrawal may cause a level of hemodynamic instability that may not be tolerated by patients with co-morbid conditions
- Withdrawal can be life-threatening in neonates
Clinical Presentation
- Time to peak and duration of symptoms depends on the half-life of the drug involved.
Estimated Time to Onset of Withdrawal
- 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 symptoms are from naloxone-induced withdrawal, typically the duration of symptoms are generally < 1 hour but can be severe
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 benzodiazepine withdrawal, patients rarely have seizures
- Altered mental status is also not part of opiod withdrawal signs
Differential Diagnosis
Diagnosis
- Clinical diagnosis
Management
- PO/IV hydration PRN
- Clonidine
- Mild opioid withdrawal - 0.1 - 0.3 mg PO
- Monitor heart rate and blood pressure and may titrate to effect
- 5mcg/kg PO (as long as SBP >90)
- Mild opioid withdrawal - 0.1 - 0.3 mg PO
- Benzodiazepines (e.g. diazepam 10-20mg IV)
- Can add with clonidine for adequate sedation
- 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