Outpatient Detoxification of the Addicted or Alcoholic Patient

clonidine for alcohol withdrawal

Current pharmaceutical and behavioral treatments may assist patients in reducing alcohol use or facilitating alcohol abstinence. Although recent research has expanded understanding of alcohol use disorder, more research is needed to identify the neurobiological, genetic and epigenetic, psychological, social, and environmental factors most critical in the etiology and treatment of this disease. Implementation of this knowledge in clinical practice and training of health care providers is also needed to ensure appropriate diagnosis and treatment of individuals suffering from alcohol use disorder. Given that α2-agonist agents (eg, clonidine and dexmedetomidine) effectively control the autonomic manifestations of AWS and have been shown to reduce agitation and other behavioral manifestations of AWS (eg, anxiety), their use in the management of AWS should be considered. The use of α2 agonists should be limited to an adjunctive role with other agents (eg, benzodiazepines or barbiturates) for the management of AWS since they have no known anticonvulsant properties. Because α2 agents (particularly dexmedetomidine) control symptoms of withdrawal and agitation without causing respiratory depression or contributing to the development of delirium (as benzodiazepines do), their use in the control of AWS should be investigated further.

7. WITHDRAWAL MANAGEMENT FOR INHALANT DEPENDENCE

Epinephrine and norepinephrine are chemical messengers that are responsible for producing your body’s “fight or flight” response. If you take clonidine with other blood pressure medications, tell your doctor if you feel dizzy or lightheaded. Your doctor may need to adjust the doses of your blood pressure medications.

Management of inhalant withdrawal

  1. Monitoring patients with routine liver function tests and red blood cell indexes may be helpful in assessing ongoing treatment compliance.
  2. However, when used for an extended period of time (e.g. several weeks), dependence can develop.
  3. For information about the effectiveness of clonidine IR oral tablets, see the “Clonidine IR oral tablet uses” section below.
  4. The risk of BZD toxicity is high during the early phase of the treatment and the patient requires a strict clinical monitoring to prevent BZD toxicity.

Beta-blockers (e.g. atenolol) could be used to treat hyperarousal symptoms in patients with coronary artery disease [74]. However, given their effect on tremors, tachycardia and hypertension, these drugs could mask AWS symptoms and should be considered only in conjunction with BZDs in patients with persistent hypertension or tachycardia [54]. There is some evidence that lithium carbonate may be an effective medication for cannabis withdrawal management.

The prevalence of daily smoking with tobacco use disorder (TUD) was 10 times that of daily…

The three-question Alcohol Use Disorders Identification Test–Consumption and the Single Alcohol Screening Question instrument have the best accuracy for assessing unhealthy alcohol use in adults 18 years and older. Two commonly used tools to assess withdrawal symptoms are the Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised, and the Short Alcohol Withdrawal Scale. Patients with mild to moderate withdrawal symptoms without additional risk factors for developing severe or complicated withdrawal should be treated as outpatients when possible. Ambulatory withdrawal treatment should include supportive care and pharmacotherapy as appropriate. Benzodiazepines are first-line therapy for moderate to severe symptoms, with carbamazepine and gabapentin as potential adjunctive or alternative therapies.

CLINICAL MANAGEMENT OF ALCOHOL WITHDRAWAL SYNDROME

Clonidine doesn’t have a high risk for misuse and isn’t classed as being addictive. If you feel sleepy, dizzy, or have blurry vision while taking clonidine, do not drive or operate machinery. And avoid other potentially dangerous activities, such as riding a bike or horse, or climbing ladders. Along with sleepiness, clonidine can also cause dizziness and blurry vision. All of these side effects can affect your ability to drive or do other potentially dangerous activities safely. If your heart rate is below 60 beats per minute, this is generally considered to be slow.

8. WITHDRAWAL MANAGEMENT FOR CANNABIS DEPENDENCE

clonidine for alcohol withdrawal

The dose of buprenorphine given must be reviewed on daily basis and adjusted based upon how well the symptoms are controlled and the presence of side effects. The greater the amount of opioid used by the patient, the larger the dose of buprenorphine required to control symptoms. Symptoms that are not satisfactorily reduced by buprenorphine can be managed with symptomatic treatment as required (see Table 3).

The first step in benzodiazepine withdrawal management is to stabilise the patient on an appropriate dose of diazepam. Calculate how much diazepam is equivalent to the dose of benzodiazepine that the patient currently uses, to a maximum of 40mg of diazepam (Table 8). To avoid the risk of overdose in the first days of treatment methadone can be given in divided doses, for example, give 30mg in two doses of 15mg morning and evening. Procedure for administering clonidine for moderate/severe opioid withdrawal. Patients should be monitored regularly (3-4 times daily) for symptoms and complications. The Short Opioid Withdrawal Scale (SOWS, p.37) is a useful tool for monitoring withdrawal.

In 1959, Friedhoff and Zitrin14 demonstrated that those who received paraldehyde recovered more quickly than did those who received chlorpromazine. In 1961, Hart16 demonstrated that there was no difference in the recovery time for patients treated with promazine and paraldehyde for DTs; however, those with less severe illness recovered faster with paraldehyde. Recent human laboratory work suggests that baclofen may disrupt the effects of an initial priming dose of alcohol on subsequent craving and heavy drinking (41). Meta-analyses and systematic reviews examining the efficacy of baclofen have yielded mixed results sleep drunkenness (35, 39, 42); however, there is some evidence that baclofen might be useful in treatment of alcohol use disorder among individuals with liver disease (43, 44). Evidence of substantial heterogeneity in baclofen pharmacokinetics among different individuals with alcohol use disorder (41) could explain the variability in the efficacy of baclofen across studies. The appropriate dose of baclofen for use in treatment of alcohol use disorder remains a controversial topic, and a recent international consensus statement highlighted the importance of tailoring doses based on safety, tolerability, and efficacy (40).

clonidine for alcohol withdrawal

The loading-dose strategy requires the administration of a moderate-to-high dose of a long-acting benzodiazepine (i.e. diazepam 10–20 mg or chlordiazepoxide 100 mg, every 1–2 hours) in order to produce sedation; successively, drug levels will decrease (auto-taper) through metabolism. The risk of BZD toxicity is high during the early phase of the treatment and the patient requires a strict clinical monitoring to prevent BZD toxicity. However, this approach seems to produce the shorter the buddhist view on addiction multiple perspectives treatment course secondary to the progressive auto-tapering of drug levels and to reduce the incidence of severe AWS promoting recovery from AWS [59]. Patients suffering from mild to moderate AWS can be managed as outpatients while more severe forms should be monitored and treated in an inpatient setting. The availability of an Alcohol Addiction Unit is of help in the clinical evaluation, management, and treatment of AWS patients, with a reduction in hospitalization costs.

clonidine for alcohol withdrawal