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Drug Withdrawal Syndromes

Published on June 2016 | Categories: Types, School Work | Downloads: 20 | Comments: 0
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DRUG WITHDRAWAL SYNDROMES
ALCOHOL
 Hyperactivity, tremor, insomnia, N/V, hallucinations, agitation,
anxiety, grand mal seizures
TREATMENT
 MILD – MOD: benzodiazepine (chlordiazepoxide, diazepam,
lorazepam)
 SEVERE: benzodiazepine and/or phenobarbital
 Insufficient evidence for: antiepileptics, beta-blockers, clonidine,
phenothiazines, baclofen
o Should never be used alone
o Can use phenothiazines (prochloperazine etc) for delirium
 Also give thiamine for prevention of wernicke’s encephalopathy
REHAB
 CBT, group-tx, self-help
 Acamprosate, naltrexone: questionable evidence

STIMULANTS
 Dysphoric mood, fatigue, vivid dreams/nightmares,
insomnia/hypersomnia, increased appetite, psychomotor
retardation or agitation
TREATMENT
 Nothing really works
o Dopamine agonists: no efficacy
o TCAs (desipramine): no efficacy
o Amphetamines/methylphenidate: may help prevent relapse
but prob not the greastest idea eh
REHAB
 Buprenorphine and methodone: maybe work
 CBT is goatee

OPIOIDS
 Dysphoric mood, N/V, muscle aches, lacrimation, rhinorrhea,
pupil dilation, piloerection, sweating, diarrhea, yawning, fever,
insomnia
TREATMENT
 Methadone, buprenorphine
o Can start within the first hour of withdrawal symptoms
o Methadone is an opioid
o Buprenorphine is like a partial agonist
 Wait 24 hours if switching from methadone to
buprenorph
 Clonidine: can help with neuroadrenergic symptoms (chills,
flushing, muscle aches, cravings) – watch out for hypotension
 Naltrexone: not effective (long-acting opioid antagonist)
Note: when you’re withdrawing opiod tx: do it like 10% at a time per
week
REHAB
 Behavioural and methadone/buprenorphine if req

BENZOS
 Autonomic hyperactivity (sweating, increased HR), hand tremor,
insomnia, N/V, hallucinations, psychomotor agitation, anxiety,
grand mal seizures
TREATMENT
 Switch to DIAZE or CLONAZE then taper
o 50% over first 2-4 weeks, then the other 50% over weeksmonths
REHAB
 TRAZODONE for sleep
 BUSPIRONE for anxiety
Benzos
 Long acting: clorazepate, chlordiazepoxide, diazepam,
flurazepam
 ALL THE REST ARE INTERMEDIATE acting (including clonazepam)
 Short acting: triazolam

NEONATAL WITHDRAWAL SYNDROME





Alcohol or BZD withdrawal: You can give phenobarb or BZDs
Cannabis, nicotine, SSRI, cocaine, amphetamine withdrawal:
supportive care
NEONATAL ABSTINENCE DISORDER refers to opiod withdrawal
only
o If the BFing mom is getting methadone… that could help
o More options: DILUTED tincture of opium with or without
phenobarb
o Clonidine: don’t use alone, but with opioids it can help

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