Combined use of trazodone-naltrexone versus clonidine-naltrexone in rapid withdrawal from methadone treatment. A comparative inpatient study.
Trazodone is a non-tricyclic antidepressant drug with specific antagonistic activities at 5-HT(2) and alpha-1 adrenoceptors. We test the efficacy of trazodone (T) compared with clonidine (C) in rapid opiate detoxification (ROD) from methadone after reduction to a daily maintenance dose </=20 mg. Forty five inpatients were consecutively assigned either to T (n=30) or to C (n=15) treatment in a 7-day ROD protocol with naltrexone administration starting at day 4. The maximum daily dosage was 800 mg for T and 1.2 mg for C. The retention rate was similar in both groups (93.3%). Overall, T was as effective as C in the ROD protocol. T was slightly superior in controlling some subjective and psychological symptoms, but not under naltexone challenge. No severe adverse effects were observed. We conclude that T is effective, safe and well-tolerated in acute withdrawal from methadone. Further investigation is needed to test the effectiveness and safety of T in ultra-rapid protocols and its usefulness in long-term administration to detoxified addicts.
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Clinical Psychiatry and Substance Dependence Unit, Institute of Psychiatry and Psychology, Faculty of Medicine 'Agostino Gemelli', Catholic University of the Sacred Heart, 00168, Rome, Italy. fdial@rm.unicatt.it
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D000293:Adolescent; D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000328:Adult; D000704:Analysis of Variance; D003000:Clonidine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000009:adverse effects*; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009294:Narcotics / Q000009:adverse effects*; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000523:psychology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D018709:Statistics, Nonparametric; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000523:psychology; D014196:Trazodone / Q000627:therapeutic use*
D000316:Adrenergic alpha-Agonists; D003000:Clonidine; D008691:Methadone; D009271:Naltrexone; D009292:Narcotic Antagonists; D009294:Narcotics; D017367:Selective Serotonin Reuptake Inhibitors; D014196:Trazodone