JOHNSON GIBBONS (LONDON) LTD. v. JILANI

Brightman, John; Henniker‐Heaton, C.; Robinson, C.G.

doi:10.1108/eb022084

Cited by 1 publication

(2 citation statements)

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“…OUD modifies serotonergic and dopaminergic pathways via the nucleus accumbens connections to limbic and autonomic brain regions, which contributes to the development of addictive behaviors and withdrawal symptoms across multiple organ systems [2]. Opioid withdrawal is fraught with many challenges mostly resulting from noradrenergic hyperactivity, with early symptoms including anxiety, agitation, aches, insomnia, sweating, yawning, and runny nose [3]. These symptoms can be severely distressing and precipitate relapse and continued opioid dependency.…”

Section: Introductionmentioning

confidence: 99%

“…Mirtazapine is a potent antagonist of serotonin (5-HT2 and 5-HT3) receptors, a strong antihistamine, and an antagonist for central alpha-adrenergic autoreceptors and heteroreceptors. Consequently, mirtazapine is sometimes described as a noradrenergic and specific serotonergic antidepressant (NaSSA) [3]. We propose a single drug, mirtazapine, as a one-drug strategy to treat symptoms of opioid withdrawal.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Mirtazapine: A One-Stop Strategy for Treatment of Opioid Withdrawal Symptoms

Lalani,

Menon,

Mufti

et al. 2023

Cureus

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Public health efforts to reduce the opioid overdose epidemic and treat opioid use disorder (OUD) have met with challenges associated with current non-standardized approaches to managing opioid withdrawal symptoms, such as itching, jitteriness, anxiety, depression, craving, vomiting, diarrhea, insomnia, and anorexia. These symptoms pose substantial obstacles to the safe initiation of medications for OUD, maintenance of long-term sobriety, and prevention of relapse. In clinical practice, multiple medications (polypharmacy) are prescribed to manage these withdrawal symptoms, including ondansetron and promethazine for vomiting and nausea, loperamide and Lomotil for diarrhea, hydroxyzine and doxepin for pruritus, benzodiazepines, the Z-drugs, and melatonin for insomnia, and benzos, tricyclic antidepressants (TCAs), and various serotonergic agents for anxiety. This polypharmacy is associated with an increased risk of adverse drug-drug interactions and adverse drug events, increased medical costs, and increased odds of medication non-adherence and relapse. We propose an alternative single medication, mirtazapine, a noradrenergic and specific serotonergic receptor antagonist, that can be used for myriad symptoms of opioid withdrawal. Case series, clinical studies, and clinical trials have shown mirtazapine to be effective for treating nausea and vomiting resulting from multiple etiologies, including hyperemesis gravidarum and chemotherapy-induced emesis. Other evidence supports the salutary effects of mirtazapine on itching and craving. Research findings support mirtazapine’s beneficial effects on diarrhea and anxiety, a consequence of its modulating effects on serotonergic receptors mediating mood and gastrointestinal symptoms. There is also evidence supporting its efficacy as a potent and non-addictive sleep aid, which presents itself as a solution for insomnia associated with opioid withdrawal. The current review presents evidence from extant literature supporting mirtazapine as a one-drug strategy to treat the variety of symptoms of opioid withdrawal. This one-drug strategy has much potential to decrease polypharmacy, adverse drug events, relapse, and healthcare cost and increase the likelihood of prolonged sobriety and better quality of life for people living with OUD.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%