Clinical Utility of Rapid Clonidine‐naltrcxone Detoxification for Opioid Abusers

Abstract

Clonidine hydrochloride (an alpha‐2 adrenergic agonist) and naltrexone hydrochloride (an opioid antagonist), given in combination, provide a safe and effective treatment of abrupt opioid withdrawal over 4 or 5 days in an outpatient/day setting. Following a naloxone challenge test to verify and quantify opioid dependence, 14 of 17 (82%) heroin users successfully withdrew from opioids and attained maintenance levels of naltrexone. Eight of 9 (89%) successfully completed the 4‐day study in which naltrexone therapy was begun on day I. Three to 5 days of clonidine hydrochloride treatment with a peak mean dose of 0.6 mg/day on day 2 for the patients in the S‐day study, and 0.5 mg on days 1 and 2 for patients in the 4‐day study, attenuated the withdrawal inducing effects of naltrexone. Both groups received naltrexone in single morning doses which were rapidly increased from 12.5 mg on the first day of naltrexone therapy to SO mg on the third day. Clonidine significantly decreased blood pressure in both groups without producing clinical problems. This study has improved the availability of the clonidine‐naltrexone combination by developing a single dose per day naltrexone regimen with naltrexone doses generally available to any opioid treatment facility. Copyright © 1988, Wiley Blackwell. All rights reserved