A normal and predictable neurophysiological response is always expected when treating with opioids and this response is called physical dependence. If not treated properly will result in withdrawal symptoms. If symptoms appear then following the protocol, symptomatic treatment starts which includes several drugs for symptomatic relief.
MOST COMMON SYMPTOMS:
· Dilated pupil
· nausea and vomiting
· cramping abdominal pains
· muscle aches
MOST COMMONLY USED DRUGS:
Clonidine is an alpha-adrenergic agonist that excites the pathway that inhibits the excitation of cardiovascular neurons. This drug is used to treat autonomic hyperactivity symptoms. The only drawback of this drug is that it causes hypotension. Compared to methadone, it has more side effects. (Jasinski et al., 1985)
0.1-0.2 mg PO Q 4-6 hours PRN
Or by transdermal patches which provide 0.1 mg per day for 7 days.
This is a carboxylic acid derivative and a selective anticholinergic and anti-spasmodic drug. It relieves the patient with muscle spasm by blocking the binding of acetylcholine with muscarinic receptors on smooth muscle thus relieves from abdominal pains. (Page & Dirnberger, 1981) Other drugs used for the same relive are:
Lomotil and Bentyl.
Hydroxyzine is an antihistamine drug used to relieve the watery eyes, itchy, runny nose, and other allergic symptoms seen with the withdrawal of opioids.
This is an antidepressant drug that acts both by serotonin transporter inhibition and the receptors. It has a major role in reliving the psychiatric effects of withdrawal for example depression, anxiety, restlessness, insomnia, etc.
Non-steroidal anti-inflammatory drugs have a major role in controlling the pain related to the withdrawal of opioids like abdominal pain and body aches. This group includes ibuprofen, acetaminophen, naproxen, diclofenac sodium, and aspirin.
Opioid withdrawal becomes difficult to treat. There are studies to show the use of ondansetron for its symptoms for example GIT side effects. Ondansetron, commonly known as Zofran, widely used to prevent nausea and vomiting. It is a serotonin 5-HT3 receptor antagonist thus blocks the serotonin with is a chemical responsible for nausea and vomiting. (Chu et al., 2017)
Alprazolam, diazepam, midazolam, lorazepam these drugs are commonly known as tranquilizers are widely used when patients with withdrawal symptoms are having anxiety issues. It works by calming the patient and induce a sedative effect by increasing the number of inhibitory neurotransmitters in the brain called GABA. (Rockville (MD), 2006)
Symptoms like diarrhea can be treated by giving loperamide. It acts by slowing down the intestinal motility and balance the water and electrolyte concentration by moving them through the bowel.
All these drugs and many more are used to treat the symptoms of withdrawal although, this is not the goal of therapy. This is just a part of the process. The main aim is to make a patient free from the adverse effects of opioids and its dependence.