Acute Management of PCP Withdrawal
PCP (phencyclidine) does not produce a physiological withdrawal syndrome requiring medical management—the primary clinical challenge is managing acute intoxication and psychological dependence, not withdrawal.
Key Clinical Reality
- No physiological withdrawal syndrome exists with PCP discontinuation 1
- In a study of 37 PCP abusers, all reported psychological dependence (liking PCP use and difficulty stopping despite adverse consequences), but none reported physiological withdrawal symptoms when stopping PCP use 1
- The clinical focus should be on managing acute intoxication symptoms and addressing psychological dependence through supportive care 2, 1
Management of Acute PCP Intoxication (Not Withdrawal)
Since withdrawal is not the clinical concern, here is the evidence-based approach for acute PCP intoxication:
Supportive Care
- Maintain vital functions with close monitoring of level of consciousness and respiration 3
- Provide psychological support and a calm, low-stimulation environment 2
- Acidification of urine to increase PCP clearance is the standard supportive measure 2
Symptom Management
For agitation and psychotic symptoms:
- Benzodiazepines (diazepam) are first-line for agitation 2
- Haloperidol has been shown to improve several symptoms of acute PCP intoxication as measured by objective clinical scales [3, @17@, @18@]
- Physostigmine (intramuscular) combined with haloperidol improved acute PCP intoxication symptoms in clinical studies [3, @17@, @18@]
Clinical Presentation to Anticipate
PCP intoxication presents with diverse symptoms including:
- Schizophrenia-like delusions and hallucinations 3
- Mania, violence, dyskinetic or catatonic movements 3
- Hypertension 3
- Muscle rigidity, ataxia, nystagmus, seizures 2
- Coma (with high doses, potentially lasting several days) 2
Long-Term Management Approach
Outpatient treatment focuses on psychological dependence, not withdrawal management:
- Group therapy sessions with regular attendance monitoring 1
- Weekly urine toxicology screening 1
- Consider residential treatment for patients who cannot maintain outpatient abstinence (30% required transfer to residential care in one study) 1
- Treatment retention averages 21 weeks, with only 11% achieving 1 year of abstinence in outpatient settings 1
Critical Pitfall: Do not confuse PCP intoxication management with withdrawal management—there is no evidence-based withdrawal protocol because physiological withdrawal does not occur with PCP cessation 1.