Effect of clonidine on vomiting and diarrhea associated with ultra-rapid opioid detoxification: a randomized clinical trial

Abstract

Introduction: Ultra-rapid opioid detoxification (UROD) as a new technique for abstinence is in progress. While diarrhea and vomiting are two frequent withdrawal symptoms, clonidine can effectively suppress such complications. This study aimed to investigate the effects of clonidine (oral) on diarrhea and vomiting during and after UROD. Methods: A double-blind randomized clinical trial was conducted in Farabi Hospital in Kermanshah, in the west of Iran. We assigned 88 patients to three groups: C1 (0.2 mg) = 29, C2 (0.4 mg) = 29 and C3 (1 mg) = 30 patients. Clonidine was gavaged to patients after general anesthesia. After that, patients were monitored for diarrhea and vomiting during (4 to 5 hours) and after (12 hours) UROD. They were matched with respect to the type of drug abused and its route of administration. Results: Three groups were comparable in terms of demographic characteristics and use of treatments except for use of different doses of propofol and midazolam. The most commonly misused drug was crack (19.3%). While there was no statistically differences between three groups in terms of development of diarrhea during UROD, the greater proportion of patients in group C1 (31.0%) developed diarrhea after UROD (P = 0.001). Three groups were comparable in terms of developing vomiting either during or after UROD. Compared with group C2 (1,248 +/- 226.4) and C3 (1,100 +/- 232.3), the mean dosage of propofol was larger among group C1 (1,336.2 +/- 248.9) (P = 0.001). Such results were similarly seen with midazolam (P = 0.04). Conclusions: Consistent with some other reports [1], this study showed that the use of larger dose of clonidine can effectively decrease the incidence of diarrhea after UROD. It can also decrease the need for larger doses of hypnotic and sedative drugs.