Withdraw from methadone

Carroll KM, Ball SA, Nich C, et al Targeting behavioral therapies to enhance naltrexone treatment of opioid dependence. Arch Gen Psychiatry 38 755-761, 2001 Centers for Disease Control and Prevention Recommendation for prevention and control of hepatitis (virus (HCV) infection and HCV-related chronic disease. MMWR Recommendations and Reports 47(RR19) l-39, 1998 Charney DS, Steinberg DE, Kleber HD, et al The clinical use of clonidine in abrupt withdrawal from methadone. Arch Gen Psychiatry 38 1273-1277, 1981 Charney D S, Heninger OR, Kleber H D The combined use of clonidine and naltrexone as a rapid, safe, and effective treatment of abrupt withdrawal from methadone. Am J Psychiatry 143 831-837, 1986... 

Senay EC Methadone maintenance treatment. Int J Addict 20 803—821, 1985 Senay EC, Dorus W, Goldberg F, et al Withdrawal from methadone maintenance rate of withdrawal and expectation. Arch Gen Psychiatry 34 361—367, 1977 Sharpe C, Kuschel C Outcomes of infants born to mothers receiving methadone for pain management in pregnancy. Arch Dis Child Fetal Neonatal Ed 89 F33—F36, 2004... 

TABLE 33-8. Sample Regimen of Clonidine for Withdrawal from Methadone (Up to 20-30 mg/day) or Equivalent Fentanyl (Duragesic ) Patches... 

D.S. Chamey, et al., The combined use of clonidines and naltrexone as a rapid, safe, and effective treatment of abrupt withdrawal from methadone. Am. J. Psychiatry 143 831-837, 1986. 

Charney DS, Sternberg DE, Kleber HD, Heninger GR, Redmond DE Jr. The chnical nse of clonidine in abrupt withdrawal from methadone. Effects on blood pressure and specific signs and symptoms. Arch Gen Psychiatry 1981 38(ll) 1273-7. 

Due to the intense study of the problem of drug addiction, the methods of treatment are improved annually. Substitution of the administration of methadone for morphine followed by withdrawal from methadone is a recent advance in withdrawal therapy. Methadone suppresses the signs of abstinence from morphine and, during rapid withdrawal of methadone, the signs of abstinence are milder than those observed during rapid withdrawal of morphine. 

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... 

As indicated, buprenorphine can offer a quicker option than methadone, with a three-day course reported to be effective for withdrawal from heroin (Cheskin et al. 1994). The side-effects of clonidine which render it unsuitable for community treatment can be manageable in the inpatient setting, although the drug is being superseded by lofexidine where that is available. Controlled studies have found clonidine and lofexidine to be equally effective in alleviating withdrawal symptoms in inpatient detoxification from heroin (Lin et al. 1997) and from methadone (Khan et al. 1997), with lofexidine resulting in less hypotension and fewer adverse effects. Another double-blind controlled study found lofexidine to be broadly as effective as a ten-day methadone detoxification in inpatient opiate withdrawal (Bearn et al. 1996). 

Therapeutic uses Methadone is used in the controlled withdrawal of addicts from heroin and morphine. Orally administered, methadone is substituted for the injected opioid. The patient is then slowly weaned from methadone. Methadone causes a milder withdrawal syndrome, which also develops more slowly than that seen during withdrawal from morphine. 

The exact frequency of fluid retention from methadone is not known. Based on a review of previous case reports, the authors suggested that the usual time necessary to develop edema is 3-6 months, but it can take several years. Marked fluid retention occurs mostly at high doses of methadone and the resultant edema is refractory to diuretics alone. Edema is reversible after withdrawal of methadone and recurs with re-challenge. The exact... 

Others have reported good results from the use of clonidine (69,70). Of 25 inpatients physically dependent on methadone, 20 were able to withdraw completely from methadone at the end of 2 weeks. In most patients, 10-11 days of clonidine, in a peak dose of 16 micrograms/kg/day, produced a perceived reduction in symptoms compared with previous attempts to become opioid-free. In these dosages, clonidine significantly reduced standing blood pressure without producing clinical problems. 

One of the limitations of clonidine treatment is that it does not appear to reduce the duration of the opioid withdrawal syndrome. In one study, 10 days of clonidine therapy were required to suppress the symptoms of opioid withdrawal from long-acting opioids such as methadone (70). 

The combined use of clonidine and naltrexone appears to allow successful withdrawal from long-term methadone therapy within 4-5 days of its abrupt withdrawal. Although patient selection may be an important consideration, the apparent success rate compares favorably with other methods and is achieved in a much shorter time (70). 

In direct addiction of post-addicts to methadone, signs of abstinence on withdrawal were identical with those seen after withdrawal of methadone subsequent to substitution from morphine. The slow recovery from methadone abstinence was more unpleasant to many subjects than abstinence from morphine. Those experimentally addicted to methadone came to prefer methadone to all other drugs. If refused morphine, many addicts will ask for either methadone or meperidine. 

Alcohol, barbiturates, and narcotics—such as diphenhydramine (Benadryl), amobarbital (Amytal), diazepam (Valium), codeine, heroin, methadone, morphine, propoxyphene (Darvon)—that are used during pregnancy can lead to harmful effects on the newborn. Use of these dmgs during pregnancy can create an addiction in the newborn. The baby will go into withdrawal from the drug when they are born. This can result in hyperactivity, crying, irritability, seizures and even sudden death. 

Yawning, rhinorrhea, and cramps are signs of withdrawal from opiates, such as heroin, meperidine, morphine, and methadone. 

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