The combination very low-dose naltrexone-clonidine in the management of opioid withdrawal

American Journal of Drug and Alcohol Abuse

Volumn 38, Issue 3, 2012, Pages 200-205

  Mannelli, Paolo ^a   Peindl, Kathleen ^a   Wu, Li Tzy ^a   Patkar, Ashwin A ^a   Gorelick, David A ^b  

^a DUKE UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b NATIONAL INSTITUTE ON DRUG ABUSE   (United States)

Author keywords

Addiction; Adrenergic; Antagonist; Detoxification; Pharmacotherapies

Indexed keywords

CLONIDINE; CYCLOBENZAPRINE; HYDROXYZINE; IBUPROFEN; LOPERAMIDE; METHADONE; NALTREXONE; NORADRENALIN; PARACETAMOL; PLACEBO; PROCHLORPERAZINE;

ADULT; ARTICLE; BONE PAIN; CONTROLLED STUDY; DIARRHEA; DOUBLE BLIND PROCEDURE; DRUG DETOXIFICATION; DRUG EFFICACY; DRUG SAFETY; FEMALE; HUMAN; LOW DRUG DOSE; MAJOR CLINICAL STUDY; MALE; MYALGIA; NAUSEA; NORADRENALIN RELEASE; OPIATE ADDICTION; OUTCOME ASSESSMENT; RANDOMIZED CONTROLLED TRIAL; SCORING SYSTEM; SECONDARY ANALYSIS; STATISTICAL SIGNIFICANCE; UNSPECIFIED SIDE EFFECT; VOMITING; WITHDRAWAL SYNDROME;

ADOLESCENT; ADRENERGIC ALPHA-2 RECEPTOR AGONISTS; ADULT; CLONIDINE; DISEASE MANAGEMENT; DOSE-RESPONSE RELATIONSHIP, DRUG; DRUG THERAPY, COMBINATION; FEMALE; HUMANS; MALE; METHADONE; NALTREXONE; NARCOTIC ANTAGONISTS; OPIATE SUBSTITUTION TREATMENT; OPIOID-RELATED DISORDERS; SUBSTANCE WITHDRAWAL SYNDROME;

EID: 84859723008     PISSN: 00952990     EISSN: 10979891     Source Type: Journal    
DOI: 10.3109/00952990.2011.644003     Document Type: Article

References (29)

1. Ruetsch C. Empirical view of opioid dependence. J Manag Care Pharm 2010; 16(1 Suppl. B):S9-S13.
2. Substance Abuse and Mental Health Services Administration. The TEDS Report: Heroin and Other Opiate Admissions to Substance Abuse Treatment. Rockville, MD: Department of Health and Human Services, 2009.
3. Carroll J, Alavi K. Pathogenesis and management of postoperative ileus. Clin Colon Rectal Surg 2009; 22(1):47-50.
4. Chutuape MA, Jasinski DR, Fingerhood MI, Stitzer ML. One-, three-, and six-month outcomes after brief inpatient opioid detoxification. Am J Drug Alcohol Abuse 2001; 27(1): 19-44.
5. Katz EC, Brown BS, Schwartz RP, O'Grady KE, King SD, Gandhi D. Transitioning opioid-dependent patients from detoxification to long-term treatment: Efficacy of intensive role induction. Drug Alcohol Depend 2011; 117(1):24-30.
6. Gowing L, Farrell M, Ali R, White JM. Alpha2-adrenergic agonists for the management of opioid withdrawal. Cochrane Database Syst Rev 2009; (2):CD002024.
7. Charney DS, Sternberg DE, Kleber HD, Heninger GR, Redmond DE, Jr. The clinical use of clonidine in abrupt withdrawal from methadone. Effects on blood pressure and specific signs and symptoms. Arch Gen Psychiatry 1981; 38(11):1273-1277.
8. Ghodse H, Myles J, Smith SE. Clonidine is not a useful adjunct to methadone gradual detoxification in opioid addiction. Br J Psychiatry 1994; 165(3):370-374.
9. Wilson RS, DiGeorge WS. Methadone combined with clonidine versus clonidine alone in opiate detoxification. J Subst Abuse Treat 1993; 10(6):529-535.
10. Kleber HD, Riordan CE, Rounsaville B, Kosten T, Charney D, Gaspari J, Hogan I, O'Connor C. Clonidine in outpatient detoxification from methadone maintenance. Arch Gen Psychiatry 1985; 42(4):391-394.
11. Schmittner J, Schroeder JR, Epstein DH, Krantz MJ, Eid NC, Preston KL. Electrocardiographic effects of lofexidine and methadone coadministration: Secondary findings from a safety study. Pharmacotherapy 2009; 29(5):495-502.
12. Gowing L, Ali R, White J. Opioid antagonists with minimal sedation for opioid withdrawal. Cochrane Database Syst Rev 2009; (4):CD002021.
13. Kosten TR, O'Connor PG. Management of drug and alcohol withdrawal. N Engl J Med 2003; 348(18):1786-1795.
14. Mannelli P, Patkar AA, Peindl K, Gorelick DA, Wu LT, Gottheil E. Very low dose naltrexone addition in opioid detoxification: A randomized, controlled trial. Addict Biol 2009; 14(2):204-213.
15. First MB, Spitzer RL, Miriam G, Williams JBW. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P). New York, NY: Biometrics Research, New York State Psychiatric Institute, 2002.
16. McLellan AT, Kushner H, Metzger D, Peters R, Smith I, Grissom G, Pettinati H, Argeriou M. The fifth edition of the Addiction Severity Index. J Subst Abuse Treat 1992; 9(3):199-213.
17. Handelsman L, Cochrane KJ, Aronson MJ, Ness R, Rubinstein KJ, Kanof PD. Two new rating scales for opiate withdrawal. Am J Drug Alcohol Abuse 1987; 13(3):293-308.
18. Kanof PD, Handelsman L, Aronson MJ, Ness R, Cochrane KJ, Rubinstein KJ. Clinical characteristics of naloxoneprecipitated withdrawal in human opioid-dependent subjects. J Pharmacol Exp Ther 1992; 260(1):355-363.
19. Walsh SL, Strain EC, Bigelow GE. Evaluation of the effects of lofexidine and clonidine on naloxone-precipitated withdrawal in opioid-dependent humans. Addiction 2003; 98(4): 427-439.
20. Gossop M. Clonidine and the treatment of the opiate withdrawal syndrome. Drug Alcohol Depend 1988; 21(3):253-259.
21. Washton AM, Resnick RB. Clonidine versus methadone for opiate detoxification. Lancet 1980; 2(8207):1297.
22. Aghajanian GK, Wang YY. Common alpha 2-and opiate effector mechanisms in the locus coeruleus: Intracellular studies in brain slices. Neuropharmacology 1987; 26(7B):793-799.
23. Jordan BA, Gomes I, Rios C, Filipovska J, Devi LA. Functional interactions between mu opioid and alpha 2Aadrenergic receptors. Mol Pharmacol 2003; 64(6):1317-1324.
24. Vilardaga JP, Nikolaev VO, Lorenz K, Ferrandon S, Zhuang Z, Lohse MJ. Conformational cross-talk between alpha2Aadrenergic and mu-opioid receptors controls cell signaling. Nat Chem Biol 2008; 4(2):126-131.
25. Mannelli P, Gottheil E, Peoples JF, Oropeza VC, Van Bockstaele EJ. Chronic very low dose naltrexone administration attenuates opioid withdrawal expression. Biol Psychiatry 2004; 56(4):261-268.
26. Van Bockstaele E, Qian Y, Sterling R, Page M. Low dose naltrexone administration in morphine dependent rats attenuates withdrawal-induced norepinephrine efflux in forebrain. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32(4):1048-1056.
27. Bennett DA, Lal H. Discriminative stimuli produced by clonidine: An investigation of the possible relationship to adrenoceptor stimulation and hypotension. J Pharmacol Exp Ther 1982; 223(3):642-648.
28. Kosten TA. Clonidine attenuates conditioned aversion produced by naloxone-precipitated opiate withdrawal. Eur J Pharmacol 1994; 254(1-2):59-63.
29. Weerts EM, Griffiths RR. Evaluation of the intravenous reinforcing effects of clonidine in baboons. Drug Alcohol Depend 1999; 53(3):207-214.