Table 3.
Symptomatic treatment of opioid withdrawal
| Withdrawal symptoms | Somatic treatment | Dosing | |
|---|---|---|---|
| Nausea and vomiting | → | Dimenhydrinate (Gravol®) | 50–100 mg PO/IM q4h prn |
| → | Prochlorperazine (Stemetil®) | 5–10 mg PO q4h prn | |
|
| |||
| Diarrhea | → | Loperamide (Imodium®) | 4 mg PO for diarrhea, then 2 mg PO prn (max: 16 mg/24 hr) |
|
| |||
| Myalgia | → | Acetaminophen (Tylenol®) | 325–650 mg PO q4h prn (max: 4,000 g/24 hr) |
| → | Naproxen (Naprosyn®) | 500 mg PO bid × 4 days, then prn | |
|
| |||
| Anxiety, dysphoria, lacrimation, rhinorrhea | → | Hydroxyzine (Atarax®) | 25–50 mg PO tid prn |
|
| |||
| Insomnia | → | Trazodone (Trazorel®) | 50–100 mg PO qhs × 4 days, then prn |
|
| |||
| ↓ Sympathetic drive (tachycardia, hypertension) diaphoresis, restlessness | → | Clonidine (Nexiclon®)a | 0.1 mg PO qid × 4 days, thenb 0.05 mg PO qid × 2 days, then 0.025 mg PO qid, then stop |
Notes:
a
Monitor blood pressure prior to each dose, as clonidine may cause hypotension
b
if <91 kg (200 lb) (doses need to be higher if >91 kg). Data source: Kosten and O’Connor55 and Kleber et al.92
Abbreviations: PO, per os; IM, intramuscular; q4h, quaque 4 hora (every 4 hours); prn, pro re nata (as needed); bid, bis in die (twice a day); tid, ter in die (three times a day); qhs, quaque hora somni (every night at bedtime); qid, quater in die (four times a day); max, maximum; hr, hours.