Signs and symptoms of opioid withdrawal and targeted management18
| Sign or symptom* | Pharmacologic management |
|---|---|
| Tachycardia, hypertension, hyperthermia, diaphoresis, lacrimation, rhinorrhea, piloerection, mydriasis, yawning | α2 agonist (clonidine, lofexidine)* |
| Anxiety, insomnia | Antihistamine (e.g., diphenhydramine, hydroxyzine), sedating antidepressant (e.g., trazodone) |
| Myalgia, bone pain | Acetaminophen, nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) |
| Abdominal cramps | Antispasmodic (e.g., dicyclomine) |
| Nausea and vomiting | Antiemetic (e.g., prochlorperazine, promethazine, ondansetron) |
| Diarrhea | Antidiarrheal (e.g., loperamide) |
| Hyperreflexia | No specific therapy |
↵* Clonidine is initiated at 0.1–0.2 mg orally every 4–6 h, with a daily maximum of 1.2 mg on day 1 and 2.0 mg afterward. Lofexidine (not available in the United States) is initiated at 0.8 mg/day in divided doses and can be titrated to a maximum of 2.4 mg/day. Both require tapering before discontinuation.