Opioid Tapering and Withdrawal
47. How rapidly can opiate analgesics be discontinued in a patient such as W.C. without precipitating withdrawal symptoms?
W.C. would benefit from long-term multidisciplinary pain management that includes behavioral therapy as well as medication adjustments. An acute pain opiate analgesic dose can be decreased in hospitalized patients by 20% daily without precipitating opiate withdrawal symptoms; but in a patient such as W.C., who has been taking opiate analgesics for an extended period of time, the decrease in analgesic dose will have to be much more gradual. In chronic opiate dependence, the opioid dose can be decreased by approximately 10% every 3 to 5 days without inducing withdrawal symptoms. The addition of clonidine can also improve the overall opioid tapering process, because it may impart analgesic effects while assisting in controlling abstinence symptoms
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