The Curbsiders Internal Medicine Podcast #392 Live! Opioid and Xylazine Withdrawal in the Hospital
6 snips
Apr 26, 2023 AI Snips
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Episode notes
Use Benzodiazepines First For Withdrawal Anxiety
- Treat xylazine withdrawal primarily with benzodiazepines titrated to symptoms, e.g., clonazepam 2 mg Q4–6 PRN for anxiety.
- Use adjuncts like clonidine, gabapentin, or tizanidine but avoid relying on high-dose clonidine alone due to hypotension risk.
Taper Benzodiazepines Before Discharge
- Titrate benzodiazepines symptom-triggered and plan to taper off within days so patients are off benzos at discharge when possible.
- Assess for underlying anxiety disorders before prolonged benzo prescribing and coordinate outpatient care if needed.
Manage Pain And Withdrawal With Full Agonists
- For acute pain plus opioid withdrawal, start full agonist long-acting opioid for dependence and short-acting opioids PRN for pain.
- Use PCA pumps when appropriate as they are safer and patient-centered for frequent short dosing.