Expect to Give Clonidine to Help Manage Opioid Withdrawal Symptoms

Patients can experience acute opioid withdrawal during a hospital stay...due to interruptions in illegal or prescription opioid use.

Withdrawal from heroin, oxycodone, or other opioids usually isn’t life-threatening like alcohol or benzodiazepine withdrawal...but it can feel unbearable.

Think of it like a bad case of flu...chills, aches, etc. And look for agitation, nausea, diarrhea, yawning, and goose bumps.

Be specific when documenting home regimens. For example, clarify how often a patient uses PRN hydrocodone/acetaminophen (Norco). A patient taking it around-the-clock can develop withdrawal if it’s held.

Watch for withdrawal symptoms 6 to 48 hours after the last dose...depending on the opioid. Plan to assess and treat symptoms using a tool, such as the Clinical Opiate Withdrawal Scale (COWS)...similar to alcohol withdrawal scales.

If you see signs of opioid withdrawal, especially when stopping “cold turkey,” expect to give clonidine...typically every 6 hours. It works by blocking chemicals in the brain that cause withdrawal symptoms.

Monitor for hypotension, bradycardia, and sedation.

You may hear about lofexidine (Lucemyra). It’s similar to clonidine and seems equally effective...but won’t be commonly used due to cost.

If symptoms persist, ask the prescriber about adding meds, such as ondansetron (Zofran) for nausea...or loperamide (Imodium) for diarrhea.

Don’t be surprised to give buprenorphine or methadone to help manage opioid withdrawal in some patients with opioid use disorder. Expect it to often be saved for those committed to long-term treatment.

And be prepared to sometimes give morphine or other short-acting opioids to manage symptoms during a hospital stay.

See our chart, Opioid Withdrawal Treatment, for more on treatment approaches...and our Neonatal Abstinence Syndrome chart for guidance on managing opioid withdrawal symptoms in newborns.

Key References
  • Cochrane Database Syst Rev. 2016 May 3;(5):CD002024
  • www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement.pdf
  • Ment Health Clin. 2018 Mar 23;7(6):282-6
  • J Psychoactive Drugs 2003;35(2):253-9
Nurse’s Letter. Sep 2018, No. 340941

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