Methadone drug withdrawal

St. John s wort This herbal remedy may induce CYP3A4 the certainty of an interaction probably rests on the specific preparation being used, but caution would dictate that this herbal product should be avoided in those receiving methadone treatment withdrawal symptoms have been noted in patients taking methadone maintenance who have added St. John s wort to their drug regimen. 

As with several other drugs, for example marijuana, PCP, and LSD, cocaine can precipitate panic disorder, which continues long after drug withdrawal (177). Among 280 patients in a methadone maintenance clinic, the prevalence of panic disorder increased from 1% to 6% over a decade (178). A marked rise in the frequency of cocaine abuse coincided with this outbreak. The authors suggested that episodes of panic occurring in cocaine users can result in hospitalization for either psychiatric or medical illnesses. 

Nonopioid. The withdrawal sjmdrome is also treatable with nonopioid drugs. Lofexidine inhibits sympathetic autonomic outflow by its agonist action on central presynaptic cc -adrenoceptors and so reduces the effects of noradrenergic hyperactivity (see above). It is similar to clonidine (see p. 482) but less likely to cause hypotension. Evidence indicates that lofexidine is as effective as methadone in withdrawal supervised in residential or community settings having no street value it is not liable to be traded. 

A 35-year old Caucasian man with AIDS and multiple opportunistic infections, including Mycobacterium kansasii and Mycobacterium avium complex (MAC) disease developed moderate to severe primary sensorineural hearing loss after 4—5 months of therapy with oral azithromycin 500 mg/day. Other medications included ethambutol, isoniazid, rifabutin, ciprofloxacin, co-trimoxazole, fluconazole, zidovudine (later switched to stavudine), lamivudine, indinavir, methadone, mod-ified-release oral morphine, pseudoephedrine, diphenhydramine, megestrol acetate, trazodone, sorbitol, salbutamol by metered-dose inhaler and nebulizer, ipratropium, and oral morphine solution as needed. Significant improvement of the hearing impairment was documented 3 weeks after drug withdrawal. 

Development of physical dependence during the longterm administration of methadone can be demonstrated by drug withdrawal or by administration of an opioid antagonist. Subcutaneous administration of 10 to 20 mg methadone to former opioid addicts produces definite euphoria equal in duration to that caused by morphine, and its overall abuse potential is comparable with that of morphine. 

Opioids (especially methadone and heroin) are the most common cause of serious neonatal drug withdrawal symptoms. Other dmgs for which a withdrawal syndrome has been reported include phencyclidine (POP), cocaine, amphetamines, tricyclic antidepressants, phenothiazines, benzodiazepines, barbiturates, ethanol, clonidine, diphenhydramine, lithium, meprobamate, and theophylline. A careful dmg history from the mother should include illicit drugs, alcohol, and prescription and over-the-counter medications, and whether she is breast-feeding. 

Drug withdrawal Stress (takotsubo) cardiomyopathy occurred in a 44-year-old man in whom severe opioid withdrawal was precipitated 2 hours after administration of naltrexone for alcohol consumption [117 ]. He had a history of heroin use and was taking methadone 120mg/day. Stress cardiomyopathy was beheved to be the result of a marked increase in catecholamine plasma concentrations following abrupt opioid withdrawal. 

Maintenance therapy is designed to reduce the patient s desire to return to the drug that caused addiction, as well as to prevent withdrawal symptoms. The dosses used vary with the patient, die length of time die individual has been addicted, and the averse amount of drug used each day. Fhtients enrolled in an outpatient methadone program for detoxification or maintenance therapy on methadone must continue to receive methadone when hospitalized. 

At present in the United States, methadone is the most commonly used drug to treat withdrawal symptoms. Detoxification can be accomplished over a period as long as 6 months in an ambulatory methadone maintenance program or as brief as several days in a hospital setting. The goal in brief detoxification is to make the experience less distressing, but the suppression of all with-... 

When patients elect detoxification from maintenance, a very gradual reduction of dosage is preferred, with careful monitoring of drug craving and withdrawal symptoms. Three to 6 months is recommended for most elective detoxifications. As many as one-third of methadone maintenance clients have been found to have a marked fear of detoxification (Milby et al. 1986). 

Kleber HD, Weissman MM, Rounsaville BJ, et al Imipramine as treatment for depression in addicts. Arch Gen Psychiatry 40 649-633, 1983 Kleber HD, Riordan CE, Rounsaville BJ, et al Clonidine in outpatient detoxification from methadone maintenance. Arch Gen Psychiatry 42 391-394, 1983 Kleber HD, Topazian M, Gaspari J, et al Clonidine and naltrexone in the outpatient treatment of heroin withdrawal. Am J Drug Alcohol Abuse 13 1-17, 1987 Kornetsky C. Brain stimulation reward, morphine-induced stereotypy, and sensitization implications for abuse. Neurosci Biobehav Rev 27 777-786, 2004 Kosten TR, Kleber HD Buprenorphine detoxification from opioid dependence a pilot study. Life Sci 42 633-641, 1988... 

A dramatically different pattern is found in surveys of drug abuse treatment facilities. Substance abuse treatment centers have reported that more than 20% of patients use benzodiazepines weekly or more frequently, with 30%— 90% of opioid abusers reporting illicit use (Iguchi et al. 1993 Stitzer et al 1981). Methadone clinics reported that high proportions ofurine samples are positive for benzodiazepines (Darke et al. 2003 Dinwiddle et al. 1996 Ross and Darke 2000 Seivewright 2001 Strain et al. 1991 Williams et al. 1996). The reasons for the high rates of benzodiazepine use in opioid addicts include self-medication of insomnia, anxiety, and withdrawal symptoms, as well as attempts to boost the euphoric effects of opioids. 

Carbamazepine is an inducer of CYP3A4 and methadone is primarily metabolized via CYP3A4 if carbamazepine is added to a drug regimen containing methadone, the methadone dose will probably need to be adjusted upward to avoid withdrawal. 

Nervirapine is an HIV drug that is a CYP3A4 inducer in a small sample, nevirapine caused a 50% reduction in methadone blood levels, resulting in complaints of methadone withdrawal symptoms in patients receiving methadone maintenance may need to increase methadone dose in patients who have nevirapine added to their drug regimen. 

An inducer of many CYP450 enzymes may result in complaints of withdrawal symptoms in methadone maintenance patients when added to their drug regimen may need to increase methadone dose. ... 

Phenytoin Similar to phenobarbital may need to increase methadone dose when phenytoin is added to a methadone maintenance drug regimen to avoid withdrawal symptoms. 

Cross-tolerance A condition where an individual who is tolerant to the pharmacological effects of one member of a drug family also shows tolerance to other members of that family. Cross-dependence allows drug substitution during detoxification (e.g., methadone for heroin or clomethiazole for ethanol), so reducing the severity and potential danger of withdrawal symptoms. 

The answer is b. (Katzungr pp 806—807J Rifampin induces cytochrome P450 enzymes, which causes a significant increase in elimination of drugs, such as oral contraceptives, anticoagulants, ketoconazole, cyclosporine, and chloramphenicol. It also promotes urinary excretion of methadone, which may precipitate withdrawal. 

Unnecessary detoxification with drugs should be avoided if possible (e.g., if symptoms are tolerable). Heroin withdrawal reaches a peak within 36 to 72 hours, and methadone withdrawal peak is reached at 72 hours. 

Conventional drug therapy for opiate withdrawal has been methadone, a synthetic opiate. Usual starting doses have been 20 to 40 mg/day. The dosage can be tapered in decrements of 5 to 10 mg/day until discontinued. Some clinicians use discontinuation schedules over 30 days or over 180 days. 

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