From the Guidelines
For clients undergoing alcohol detoxification while taking methadone, appropriate as-needed medications include trazodone, clonidine, hydroxyzine, and lorazepam, with careful consideration of the risks and benefits of each medication, particularly the potential for respiratory depression with benzodiazepines like lorazepam 1.
Medication Options
- Trazodone 50-100mg at bedtime for insomnia, as it is a commonly used medication for this purpose, although its efficacy for insomnia is not well established 1
- Clonidine 0.1-0.2mg every 4-6 hours for hypertension, anxiety, and autonomic symptoms, as it is an alpha2 agonist that can help manage these symptoms 1
- Hydroxyzine 25-50mg every 6 hours for anxiety and nausea, as it is an anxiolytic medication that can help alleviate these symptoms
- Lorazepam 1-2mg every 4-6 hours for severe withdrawal symptoms and seizure prevention, as it is a benzodiazepine that is commonly used for this purpose, although it should be used cautiously due to the risk of respiratory depression, particularly when combined with methadone 1
Important Considerations
- Benzodiazepines, such as lorazepam, should be used cautiously with methadone due to the risk of respiratory depression 1
- Vital signs monitoring is essential, particularly during the first 72 hours of detox, to ensure the safe use of these medications
- The methadone dose should be continued as prescribed to prevent opioid withdrawal complications
- Clinical assessment using the CIWA-Ar scale can help determine appropriate medication administration timing and dosing
Additional Recommendations
- Thiamine 100mg daily to prevent Wernicke's encephalopathy, as recommended by the WHO guidelines for the management of alcohol withdrawal 1
- Ondansetron 4-8mg every 8 hours for nausea and vomiting, as it is an antiemetic medication that can help alleviate these symptoms
- Ibuprofen 400-600mg every 6 hours for pain and discomfort, as it is a nonsteroidal anti-inflammatory medication that can help alleviate these symptoms
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medications for Alcohol Detoxification with Methadone
- The use of benzodiazepines is recommended as the first line treatment for alcohol withdrawal syndrome, as stated in major guidelines 2.
- The association of anticonvulsivants, adrenergic alpha-2 agonists, betablockers, and antipsychotics with benzodiazepines is recommended for symptom reduction in severe alcohol withdrawal syndrome 2.
- Clonidine has been found to be effective in the treatment of methadone withdrawal, with a peak mean dose of 16 micro g /kg/day resulting in a perceived reduction in symptoms 3.
- Clonidine can be used to alleviate symptoms of methadone withdrawal, including anxiety, restlessness, insomnia, and muscular aching, although these symptoms may be resistant to treatment 3.
- Hydroxyzine may be used as an alternative to benzodiazepines for the treatment of anxiety and insomnia in patients undergoing alcohol detoxification, although its use is not specifically mentioned in the provided studies.
- Trazodone may be used to treat insomnia and anxiety in patients undergoing alcohol detoxification, although its use is not specifically mentioned in the provided studies.
Considerations for Methadone Detoxification
- Methadone maintenance treatment should not necessarily be maintained for life and can be stopped within its prescription setting, including medical, psychological, and social evaluation 4.
- A slow tapering of the methadone dose is recommended, with the ability to go back to the previous dose if needed, particularly in case of relapse to heroin use, heavy withdrawal, or psychiatric symptoms 4.
- Gabapentin has been found to be an effective add-on therapy to methadone, leading to relief of withdrawal symptoms and lower methadone consumption 5.