Opioid withdrawal

Background

• Uncomfortable but not life-threatening
• Onset is 6-12hr after last heroin use, within 30hr after last methadone use

Clinical Features

1. Onset: within hours of cessation
2. Peak effects: 36-72hr
   1. Anxiety
   2. Craving
   3. Yawning
   4. Rhinorrhea
   5. Diaphoresis
3. Onset: 12hr after cessation
4. Peak effects: 72hr
   1. Tremor
   2. Piloerection
   3. Mydriasis
   4. Irritability
5. Onset: 24-36hr after cessation
6. Peak effects: 72hr
   1. Muscle spasm
   2. Abd pain
   3. N/V/D

Treatment

1. Clonidine
   1. 5mcg/kg PO (as long as SBP >90)
2. Hydroxyzine
   1. 50-100mg PO QID x5d
3. Antiemetics
4. Antidiarrheals
5. NSAIDS
6. PO/IV hydration

Source

• Tintinalli