Features and overview

Consider use of adjuvant medications during the taper to reduce withdrawal symptoms. The first-line treatment option for autonomic symptoms such as sweating, tachycardia, myoclonus is clonidine 0.1 to 0.2 mg oral every 6 to 8 hours; hold dose if blood pressure <90/60 mmHg (0.1 to 0.2 mg 2 to 4 times daily is commonly used in the outpatient setting); recommend test dose (0.1 mg oral) with blood pressure check 1 hour post dose; obtain daily blood pressure checks; increasing dose requires additional blood pressure checks; re-evaluate in 3 to 7 days; taper to stop; average duration 15 days. The three alternative treatment options for autonomic symptoms are Baclofen, Gabapentin, Tizanidine. The alternative treatment option for autonomic symptoms using Baclofen is as follows: 5 mg 3 times daily; may increase to 40 mg total daily dose; re-evaluate in 3 to 7 days; average duration 15 days; may continue after acute withdrawal to help decrease cravings; should be tapered when it is discontinued. The alternative treatment option for autonomic symptoms using Gabapentin is as follows: start at 100 to 300 mg and titrate to 1800 to 2100 mg divided in 2 to 3 daily doses; adjust dose if renal impairment. Gabapentin can help reduce withdrawal symptoms and help with pain, anxiety, and sleep. The alternative treatment option for autonomic symptoms using Tizanidine is as follows: 4 mg three times daily, can increase to 8 mg three times daily.

Question: What to consider to reduce withdrawal symptoms during the taper?
Answer: use of adjuvant medications

Question: What is the first-line treatment option for autonomic symptoms?
Answer: clonidine 0.1 to 0.2 mg oral every 6 to 8 hours

Question: When to hold dose if administering clonidine for autonomic symptoms?
Answer: if blood pressure <90/60 mmHg (0.1 to 0.2 mg 2 to 4 times daily is commonly used in the outpatient setting)

Question: What is the recommended dose if blood pressure <90/60 mmHg while administering clonidine for autonomic symptoms?
Answer: 0.1 mg oral

Question: What do autonomic symptoms include?
Answer: sweating, tachycardia, myoclonus

Question: What are the alternative treatment options for autonomic symptoms?
Answer: Baclofen, Gabapentin, Tizanidine

Question: What is the alternative treatment option for autonomic symptoms using Baclofen?
Answer: 5 mg 3 times daily; may increase to 40 mg total daily dose; re-evaluate in 3 to 7 days; average duration 15 days; may continue after acute withdrawal to help decrease cravings; should be tapered when it is discontinued

Question: What is the alternative treatment option for autonomic symptoms using Gabapentin?
Answer: start at 100 to 300 mg and titrate to 1800 to 2100 mg divided in 2 to 3 daily doses; adjust dose if renal impairment

Question: Which can help reduce withdrawal symptoms and help with pain, anxiety, and sleep?
Answer: Gabapentin

Question: Which can help reduce withdrawal symptoms?
Answer: Gabapentin

Question: Which can help with pain, anxiety, and sleep?
Answer: Gabapentin

Question: Gabapentin can help reduce what?
Answer: withdrawal symptoms and help with pain, anxiety, and sleep

Question: What is the alternative treatment option for autonomic symptoms using Tizanidine?
Answer: 4 mg three times daily, can increase to 8 mg three times daily