Opiate Withdrawal Treatment

•    Clonidine 0.1 mg po TID – QID with 0.1 mg po q 2 h prn for  BP > 150/100, P > 100

•    Bentyl 20 mg po QID prn abdominal cramps

•    Robaxin 500 mg – 750 mg two (1000-1500 mg) po q8h prn muscle cramps,  SOMA 350 mg q6h prn

•    Tramadol/Ultram 50mg q6h x 4 days for severe muscle cramps

•    Pepto-Bismol 2 tsp q6h, Imodium 4 mg after 1st loose stool, then 2mg per stool not to exceed 16mg/24 hours

•    Antacid of choice—Maalox, Mylanta 30cc q6h prn  indigestion

•    Laxative of choice—MOM 30cc

•    Phenergan 25 mg PO, IM, or IV q 4 h prn nausea

•    If seizures, Valium 2mg/min slow IV push, until seizure activity stops (10 mg maximum dose)

Withdrawal Delirium:  Benzodiazepines, Barbiturates, and Alcohol

•    Fixed and symptom – triggered schedule

Ativan 1-2 mg po, IM or IV q 4-6 h and

Ativan 1-2 mg po, IM or IV q 1-2 h prn; or

Valium 10 mg po TID and

Valium 10 mg po q1-2h prn; or

Librium 25-50 mg x 1 then 25 mg q6h and

Librium 25mg po q1-2 h prn.

PRN:  P>100, BP> 150/100; Hold for sedation

Add total in 24 hours and taper Valium/Librium 3-5 days and Ativan 10 to 14 days (For Ativan, decrease dose primarily, maintain frequency q 6h as much as possible)

•    Or, give symptom – triggered schedule alone, if more appropriate

•    Thiamine 100 mg po q daily

•    MVI  1 po q daily

•    Folic acid 1 mg po q daily

•    Magnesium Sulfate 50% 2 ml IM daily x 3 if magnesium level < 1.4 (UMC)

•    Tegretol 200mg bid during hospital stay if history of seizures

•    Ibuprophen 600 mg PO q6h prn pain

•    Trazadone 50mg PO qhs prn sleep.  May repeat in 1 hour.

•    Vistaril 50mg PO qhs prn sleep.

Outpatient Detoxification and Follow-up Plan

(If vital signs stabilize on benzos, consider outpatient detox.  If unstable withdrawal, needs inpatient medical detox)


•    Alcohol, Benzos, Barbs – Valium 10 mg, Librium 50 mg TID – QID. Taper over 5-7 days.  Prescribe about 5-7 prn doses.

•    Call AA/NA hotline and have representative engage patient in the ER.

•    Prescribe bidaily or daily AA/NA meetings for 2 weeks.

•    Go to Addiction Disorder Clinic the same or next day and get appointment.

•    Call residential treatment centers daily.