Pharmacological strategies for detoxification

Diaper, Alison; Law, Fergus; Melichar, J

doi:10.1111/bcp.12245

Cited by 51 publications

(29 citation statements)

References 128 publications

(124 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The use of clonidine may be limited by hypotension or bradycardia, making it difficult to use in an outpatient setting. 17 Some data support the use of anticonvulsants and antidepressants as adjuncts for opioid withdrawal symptoms. Gabapentin, at doses up to 1600 mg per day over 3 weeks was found to reduce symptoms of coldness, dysphoria, diarrhea, yawning, and muscle tension.…”

Section: Adjunctive Therapymentioning

confidence: 99%

A practical guide to tapering opioids

Král¹,

Jackson²,

Uritsky³

2015

Mental Health Clinician

View full text Add to dashboard Cite

Tapering opioids is one of the most daunting dilemmas in clinical practice today. The decision to taper opioids is based on many factors, including a lack of efficacy, unacceptable risk, perioperative management, noncompliance, or patient preference. Tapering in the perioperative setting is quite common, though more complex in patients previously taking chronic opioid therapy. Outside of a medical emergency, opioid tapers are best managed in an outpatient setting, allowing for adjustments and more long-term nonopioid pain management, if necessary. No single strategy can be applied to all patients, and very few published guidelines are available for reference. Dose reductions and schedules are highly variable across available guidelines and literature. Dose reductions range from 10% to 50%, with a frequency ranging from daily reductions to every 2 weeks. Most guidelines address the concern of preventing physical withdrawal symptoms; however, few address the psychological ramifications of tapering. Individualized regimens and a willingness to adjust schedules and doses allows for improved patient comfort. The goal is to complete tapering without any symptoms of withdrawal; however, this is not always possible. Several available agents may help ameliorate these symptoms, including antihypertensives, antihistamines, antiemetics, antidepressants, anticonvulsants, and antipsychotics. Opioid tapering is rarely easy but should be a manageable process.

show abstract

Section: Adjunctive Therapymentioning

confidence: 99%

A practical guide to tapering opioids

Král¹,

Jackson²,

Uritsky³

2015

Mental Health Clinician

View full text Add to dashboard Cite

show abstract

“…Without adequate treatment, many patients are unable to complete opioid discontinuation (Mattick et al 2008;Kosten and Baxter 2019) as avoidance of symptoms of opioid withdrawal often becomes the most powerful force driving continued use (Cicero and Ellis 2017). Besides buprenorphine and methadone, some supportive pharmacotherapeutic agents are available to mitigate uncomfortable symptoms associated with acute phase treatment including clonidine, baclofen, ibuprofen and lofexidine (Kleber 2007;Diaper et al 2014). However, the overall effectiveness of the supportive medications is not satisfactory (Hermann et al 2005).…”

Section: Introductionmentioning

confidence: 99%

Auricular neural stimulation as a new non-invasive treatment for opioid detoxification

et al. 2020

View full text Add to dashboard Cite

The recent opioid crisis is one of the rising challenges in the history of modern health care. New and effective treatment modalities with less adverse effects to alleviate and manage this modern epidemic are critically needed. The FDA has recently approved two non-invasive electrical nerve stimulators for the adjunct treatment of symptoms of acute opioid withdrawal. These devices, placed behind the ear, stimulate certain cranial nerves with auricular projections. This neural stimulation reportedly generates a prompt effect in terms of alleviation of withdrawal symptoms resulting from acute discontinuation of opioid use. Current experimental evidence indicates that this type of non-invasive neural stimulation has excellent potential to supplement medication assisted treatment in opioid detoxification with lower side effects and increased adherence to treatment. Here, we review current findings supporting the use of non-invasive neural stimulation in detoxification from opioid use. We briefly outline the neurophysiology underlying this approach of auricular electrical neural stimulation and its role in enhancing medication assisted treatment in treating symptoms of opioid withdrawal. Considering the growing deleterious impact of addictive disorders on our society, further studies on this emerging treatment modality are warranted.

show abstract

“…Opioid addiction is a significant cause of morbidity and mortality and has great social costs (Diaper, Law, & Melichar, ). Opioid withdrawal symptoms include dysphoria, nausea, vomiting, muscle aches, lacrimation, rhinorrhea, pupillary dilatation, piloerection, diarrhea, yawning, fever, and insomnia.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of Sophora alopecuroides var. alopecuroides seed extract for opioid detoxification: A randomized, double‐blind, and placebo‐controlled clinical trial

Kianbakht

Hajiaghaee

Akhondzadeh

2019

Phytotherapy Research

View full text Add to dashboard Cite

The seeds of Sophora alopecuroides L. var. alopecuroides (S. alopecuroides) have alleviated morphine withdrawal in mice. Therefore, in this study, the alkaloid composition of S. alopecuroides extract was determined by gas chromatography (GC) and gas chromatography-mass spectrometry (GC-MS) analysis. Moreover, 50 abstinent opium addicts consumed three 400 mg extract capsules once daily and 50 other patients took placebo for 8 days. At the baseline and days 3 and 8, the clinical opiate withdrawal scale (COWS) was used to assess withdrawal symptoms. At the baseline and Day 8, the patients' blood levels of serum glutamate oxaloacetate transferase; serum glutamate pyruvate transferase; alkaline phosphatase; total, direct, and indirect bilirubins; creatinine and blood urea nitrogen; complete blood count; and prothrombine time were measured. The groups' parameter values were also compared.Sophocarpine, matrine, and sophoramine were the major alkaloids constituting, respectively, 32.85, 26.55, and 6.91% of the extract. The extract decreased the COWS score at Days 3 and 8 significantly compared with the placebo (p < .001). The extract did not significantly affect the blood parameters' values compared with the placebo (p > .05). There was no adverse drug effect. In conclusion, the extract reduces the acute opioid withdrawal symptoms and seems to have good safety and tolerability. K E Y W O R D Sdetoxification, opioid, Sophora alopecuroides, withdrawal

show abstract

Pharmacological strategies for detoxification

Cited by 51 publications

References 128 publications

A practical guide to tapering opioids

A practical guide to tapering opioids

Auricular neural stimulation as a new non-invasive treatment for opioid detoxification

Efficacy and safety of Sophora alopecuroides var. alopecuroides seed extract for opioid detoxification: A randomized, double‐blind, and placebo‐controlled clinical trial

Contact Info

Product

Resources

About