The Effect of Clonidine on Gastrointestinal Side Effects Associated with Ultra-Rapid Opioid Detoxification

Mā, Hong; Tang, Jun; White, Paul F.; Wender, Ronald H.; Leverone, Thomas; Quon, Rayond; Pearce, Scott; Chiao, Franklin; Erice, Susan

doi:10.1213/01.ane.0000060451.82578.3a

Cited by 10 publications

(5 citation statements)

References 16 publications

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“…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.…”

Section: Discussionsupporting

confidence: 92%

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

Farzam

Najafi²

2009

Critical Care

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Section: Discussionsupporting

confidence: 92%

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

Farzam

Najafi²

2009

Critical Care

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“…Psychological counselling and treatment with clonidine, an α ‐adrenergic agonist, are indicated for opiate withdrawal symptoms 91,92 . It acts on α 2 ‐receptors in the central nervous system and in the gut wall and enhances the management of pain and opioid withdrawal with predominant gut involvement.…”

Section: Narcotic Bowel Syndromementioning

confidence: 99%

Opioids and the gut: pharmacology and current clinical experience

Schepper¹,

Cremonini²,

Park³

et al. 2004

Neurogastroenterology Motil

194

146

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This article reviews the pharmacology and physiology of opiate receptors and the current and potential uses of opioid agonists and antagonists in clinical gastroenterology. Mu-receptors are involved in motor and sensory functions, and their modulation is established for treatment of diarrhea. Mu-antagonists have potential to reverse endogenous (e.g., postoperative ileus) or iatrogenic dysmotility (e.g., opioid bowel dysfunction). Modulation of the function of kappa-receptors may be a novel approach to control visceral pain in functional gut disorders. Results of formal testing of novel opioid modulators are keenly awaited.

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“…Loperamide, a piperidine derivative, has also been used in the past because it slows gastrointestinal motility through a direct effect on the nerve endings and the intramural ganglia of the intestinal wall 48 . Studies suggest that clonidine itself, when used to control sympathetic symptoms, has intrinsic, dose‐related antidiarrheal activity 49 …”

Section: Problems After Urodmentioning

confidence: 99%

“…48 Studies suggest that clonidine itself, when used to control sympathetic symptoms, has intrinsic, dose-related antidiarrheal activity. 49 Naltrexone reliably reduces feelings of craving, by unclear neuropharmacological mechanisms. This suggests that long-term naltrexone therapy may be warranted.…”

Section: Problems After Urodmentioning

confidence: 99%

Chronic Pain and Ultrarapid Opioid Detoxification

et al. 2005

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Availability of opiate substances through physicians and on the street has led to a rise in dependence and in addiction resulting in countless numbers of people hooked on these drugs. Long-term use of these agents results in reduction of endogenous supply of opiate replaced by these exogenous compounds. A technique known as Ultrarapid Detoxification (UROD) has been developed and appears more promising than conventional modalities. UROD has been modified over 3 decades resulting in a safe and an effective general anesthetic that results in hemodynamically stable withdrawal without manifestation of central nervous system hyperarousal. A cornerstone of this technique involves clonidine, which stimulates reuptake of catecholamines and allows for large doses of opioid antagonist to be delivered without significant changes in heart rate or blood pressure, displacing the opiate. Though techniques vary from center to center, safety should be paramount with the technique performed in an intensive care unit with trained professional anesthesiologists. Psychosocial issues should be evaluated by a trained addictionalist and most people will succeed from the UROD procedure without experiencing the horrible withdrawal syndrome. Patients must have realistic goals and be prepared to deal with psychosocial issues post-procedure.

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The Effect of Clonidine on Gastrointestinal Side Effects Associated with Ultra-Rapid Opioid Detoxification

Abstract: Clonidine, an alpha(2)-adrenergic agonist, is used to minimize withdrawal symptoms related to ultra-rapid opioid detoxification procedures. These preliminary data suggest that clonidine possesses dose-related antidiarrheal activity.

Cited by 10 publications

References 16 publications

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

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

Opioids and the gut: pharmacology and current clinical experience

Chronic Pain and Ultrarapid Opioid Detoxification

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