From the Guidelines
Ancillary medications used in the management of opioid use disorder include α2-agonists like clonidine, lofexidine, and tizanidine to mitigate withdrawal symptoms, as well as medications to address anxiety, insomnia, and gastrointestinal discomfort, such as trazodone, gabapentin, and loperamide. When managing opioid use disorder, it is crucial to consider the use of ancillary medications to alleviate symptoms associated with opioid withdrawal and to improve the patient's quality of life.
Medications for Withdrawal Symptoms
- α2-agonists, such as clonidine, are effective in reducing withdrawal symptoms by directly attenuating opioid withdrawal, although they may cause orthostasis or hypotension, necessitating careful titration 1.
- Lofexidine is FDA-approved for controlling opioid withdrawal symptoms and is considered when patients cannot tolerate clonidine due to its side effects.
- Tizanidine, another α2-agonist, is less effective than clonidine but less likely to cause hypotension.
Medications for Anxiety, Insomnia, and Irritability
- Trazodone, gabapentin, and mirtazapine have been reported to be beneficial for short-term use in mitigating anxiety, insomnia, and irritability associated with opioid withdrawal 1.
- These medications do not specifically counteract the physiologic changes of opioid withdrawal but can significantly improve the patient's comfort and adherence to treatment.
Gastrointestinal Symptoms
- Loperamide can be used to manage gastrointestinal discomfort, such as diarrhea, but clinicians should be aware of its potential for abuse and the risk of dangerous arrhythmias at high doses 1.
In the context of opioid use disorder management, the selection of ancillary medications should be guided by the most recent and highest-quality evidence, prioritizing those that have been shown to effectively mitigate withdrawal symptoms and improve patient outcomes, such as clonidine and lofexidine for withdrawal symptoms, and trazodone or gabapentin for anxiety and insomnia 1.
From the Research
Ancillary Medications for Opioid Use Disorder
The management of opioid use disorder (OUD) often involves the use of various medications to help alleviate symptoms and support recovery. Some of the key ancillary medications used in this context include:
- Methadone: a full opioid agonist that helps suppress opioid withdrawal symptoms and reduce cravings 2, 3, 4
- Buprenorphine: a partial opioid agonist that also helps manage withdrawal symptoms and cravings, with the added benefit of having a ceiling effect to reduce the risk of overdose 2, 5, 3, 4
- Naltrexone: an opioid antagonist that blocks the effects of opioid agonists, helping to prevent relapse 2, 3, 4
- Clonidine: a centrally acting alpha-2 selective adrenergic receptor agonist that can be used to manage opioid withdrawal symptoms, although its use is controversial and requires careful consideration 6
- Naloxone: an opioid antagonist used to reverse opioid overdose, often provided as a take-home medication to help prevent fatal overdoses 2
Considerations for Treatment
When selecting ancillary medications for OUD, it's essential to consider the individual's specific needs and circumstances. Factors such as the severity of their addiction, medical history, and potential for medication interactions or diversion should be taken into account 5, 3, 4. Additionally, the use of medication-assisted treatment (MAT) should be complemented by non-pharmacological interventions, such as counseling and support groups, to provide a comprehensive approach to recovery 5, 3.