Drug Withdrawal: Symptoms and Treatment

Question 1

Alcohol

Answer 1

Tremor (6-12 hours).

Tachycardia, hypertension, agitation, seizures (within 48 hours).

Hallucinations, Delirium Tremens–severe autonomic instability leading to tachycardia, delirium, and possibly death (within 2-7 days). Mortality is 15-20%.

Tx: BENZODIAZEPINES (can require massive doses); haloperidol for hallucinations; THIAMINE, folate, and multivitamin replacement (do not affect withdrawal, but most alcoholics are deficient).

Question 2

Barbiturates

Answer 2

Anxiety, seizures, delirium, tremor; tachycardia and hypertension

Tx: Benzodiazepines

Question 3

Benzodiazepines

Answer 3

Rebound anxiety, seizures, tremor, insomnia

Tx: BDZ taper

Question 4

Cocaine / amphetamines

Answer 4

Depression, hyperphagia, hypersomnolence

Supportive Treatment. Avoid pure beta-blockers (may lead to unopposed alpha activity, causing hypertension).

Question 5

Opioids

Answer 5

Anxiety, insomnia, flu-like symptoms, piloerection, fever, rhinorrhea, lacrimation, yawning, nausea, stomach cramps, diarrhea, mydriasis

Tx: antiemetics, muscle relaxers, and NSAIDS for mild symptoms; clonidine, buprenorphine, or methadone for moderate to severe symptoms.