Opioid Withdrawal

Opioid Withdrawal:

Sx: restless, anxious, agitated, diarrhea and/or abdominal cramping, dilated pupils

Increase RR, increase BP

  • Admit to a telemetry
  • Bedrest: Complete
  • Vital signs q4hrs.
  • Toxicology: Plasma alcohol level, UDP (urine drug panel), Opiates conformation/quantitation (blood), UA, CBC, CMP.
  • Initiate opiate withdrawal protocol. Do not give patient any narcotics.  Haldol PRN was also added for agitation. [“Initiate Behavioral Health Adult Opiate Detox Protocol”]
    • Control BP in withdrawal: Clonidine (Catapres) 0.1mg PO – To prevent withdrawal symptoms. Hold any dose if SBP is less than 90mmHg, DBP less than 60mmHg, or HR less than 60bpm.
      1. Clonidine (Catapres) 0.1mg PO q8hr for 1 day (Day 3 of admission X 1 day) – designate date to start on (specify date of “Day 3 of admission.”)
      2. Clonidine (Catapres) 0.1mg PO q12hr for 1 day (Day 4 of admission X 1 day) – designate date to start on (specify date of “Day 4 of admission.”)
      3. Clonidine (Catapres) 0.1mg PO qd for 1 day (Day 5 of admission X 1 day) – designate date to start on (specify date of “Day 5 of admission.”)
        • PRN Clonidine: 0.1mg PO q2hr PRN SBP, DBP, HR
          • Give if 2 or more of the following 3 occur simultaneously:
            1. 1. SBP > 160, 2. DBP>90, 3. HR>100bpm.
          • May be used in addition to scheduled doses.
  • Dicyclomine (Bentyl) 20mg PO q6hr PRN abdominal cramping
  • Diphenhydramine (Benadryl) 25mg IV q6hr PRN agitation
  • Haloperidol (Haldol) 2mg IM q6hr PRN agitation
  • Hydroxyzine HCl (Vistaril) 25mg IM q4hr PRN nausea and/or vomiting
  • Loperamide (Imodium) 2mg PO q4hr PRN diarrhea (max dose: 16mg/24hrs)
  • Lorazepam (Ativan) 1mg PO q4hr PRN signs/symptoms of withdrawal for 3 days
    • Ex: anxiety, agitation, diaphoresis, tremulousness, SBP>150mmHg, DBP>90mmHg, and/or HR>100bpm.
  • Methocarbamol (Robaxin) 750mg PO q6hr PRN muscle aching/cramping.
  • Continue all patient’s home medications other than his methadone.
  • May need to place the patient in soft restraints as he is harm to self.
  • Lovenox 40mg SubQ qd.
  • Protonix 40mg PO qd.
  • Diet: NPO – except meds with sips of water

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