Table 1:

Signs and symptoms of opioid withdrawal and targeted management18

Sign or symptom*Pharmacologic management
Tachycardia, hypertension, hyperthermia, diaphoresis, lacrimation, rhinorrhea, piloerection, mydriasis, yawningα2 agonist (clonidine, lofexidine)*
Anxiety, insomniaAntihistamine (e.g., diphenhydramine, hydroxyzine), sedating antidepressant (e.g., trazodone)
Myalgia, bone painAcetaminophen, nonsteroidal anti-inflammatory drugs (e.g., ibuprofen)
Abdominal crampsAntispasmodic (e.g., dicyclomine)
Nausea and vomitingAntiemetic (e.g., prochlorperazine, promethazine, ondansetron)
DiarrheaAntidiarrheal (e.g., loperamide)
HyperreflexiaNo 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.