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 wernickes 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 youre 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: dont use alone, but with opioids it can help