Drug Withdrawal

Aka: Drug Withdrawal, Substance Withdrawal, Chemical Withdrawal, Medication Withdrawal

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II. Symptoms: General

  1. Agitation
  2. Anxiety
  3. Diaphoresis
  4. Tachycardia
  5. Tremor
  6. Malaise
  7. Nausea and Vomiting
  8. Diarrhea
  9. Dysphoria or depressed mood
  10. Insomnia

III. Signs: Specific per agent

  1. Alcohol Withdrawal signs
    1. Symptoms mild for first 24 hours and severe by 72 hours (overall lasting 1-2 weeks)
    2. Hallucinations
    3. Tremors
    4. Seizures
  2. Opioid Withdrawal signs
    1. Symptoms peak in 72-96 hours and last 2 weeks for Methadone
    2. Symptoms peak in 36-72 hours and last 7-10 days for Heroin
    3. Diarrhea
    4. Mydriasis
    5. Cramps
  3. Benzodiazepines or Barbiturate withdrawal signs
    1. Symptoms peak in 5-9 days (overall lasting 10-14 days); Variable based on specific agent
    2. Seizures
    3. Agitation
  4. Stimulant withdrawal
    1. Symptoms peak in 2-4 days (and depressed mood symptoms may persist for weeks)
    2. Depressed mood
  5. Antihypertensive withdrawal signs
    1. Hypertension
    2. Tachycardia

IV. Causes: Agents with severe withdrawal

  1. Drugs of Abuse
    1. Alcohol Withdrawal
    2. Opioid Withdrawal
    3. Benzodiazepine Withdrawal
    4. Barbiturate withdrawal
    5. GHB Withdrawal
  2. Prescription medications
    1. Intrathecal Baclofen Withdrawal
    2. Venlafaxine Withdrawal
    3. Clonidine Withdrawal

V. Causes: Prescription medications with withdrawal potential

  1. Amphetamine Withdrawal
    1. Dexmethylphenidate (Focalin)
    2. Amphetamine-Dextroamphetamine (Adderall)
    3. Methylphenidate (Ritalin)
  2. Anticonvulsant Withdrawal
    1. Carbamazepine (Tegretol)
    2. Lamotrigine (Lamictal)
    3. Topiramate (Topamax)
  3. Antidepressant Withdrawal
    1. Selective Serotonin Reuptake Inhibitors (SSRI)
    2. Serotonin Norepinephrine Reuptake Inhibitors (SNRI, especially Venlafaxine)
    3. Tricyclic Antidepressants
  4. Antipsychotic withdrawal
    1. Clozapine (Clozaril)
    2. Fluphenazine (Prolixin)
    3. Olanzapine (Zyprexa)
    4. Haloperidol (Haldol)
    5. Risperidone (Risperdal)
    6. Ziprasidone (Geodon)
  5. Barbiturate withdrawal
    1. Phenobarbital
  6. Beta Blocker Withdrawal
    1. Carvedilol (Coreg)
    2. Metoprolol (Toprol, Lopressor)
    3. Propranolol (Inderal)
  7. Benzodiazepine Withdrawal
    1. Alprazolam (Xanax)
    2. Lorazepam (Ativan)
    3. Diazepam (Valium)
    4. Temazepam (Restoril)
  8. Dopamine Agonist withdrawal
    1. Amantadine
    2. Pramipexole (Mirapex)
    3. Ropinirole (Requip)
  9. Hypnotic withdrawal
    1. Eszopiclone (Lunesta)
    2. Zaleplon (Sonata)
    3. Zolpidem (Ambien)
  10. Opioid Withdrawal
    1. Hydrocodone
    2. Methadone
    3. Morphine
    4. Oxycodone
    5. Tramadol
  11. Corticosteroid withdrawal
    1. Dexamethasone
    2. Methylprednisolone
    3. Prednisone

VI. References

  1. Mishler and Lovecchio (2017) Crit Dec Emerg Med 31(11): 15-20

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