Reduction of opioid-withdrawal symptoms with quetiapine.
OBJECTIVE
To determine the utility of quetiapine in a population undergoing ambulatory detoxification from opioids.


METHODS
Medications utilized in our outpatient clinic for opioid withdrawal were evaluated for quality-assurance purposes. The treatment regimen generally included clonidine, hydroxyzine, trazodone, diphenoxylate/atropine, and sometimes chlordiazepoxide. Patients were also initially given eight 25-mg tablets of quetiapine and instructed to take 1 or 2 tablets every 4 hours as needed for symptoms of withdrawal or craving (with a maximum daily dose of 200 mg). Data were based on patient evaluations from June 2003 to June 2004.


RESULTS
41% of all patients (N = 213) successfully completed the detoxification phase of the program (i.e., completed at least 5 days of abstinence). A medication questionnaire was instituted for quality-assurance purposes after some apparent initial success with quetiapine. A retrospective analysis of these data revealed that, of the 107 patients evaluated for medication response, 79 reported that quetiapine helped reduce craving for opioids, 52 reported that quetiapine helped reduce their anxiety, 24 reported a reduction in somatic pain, 22 reported that quetiapine helped alleviate insomnia, and 14 reported an improved appetite. Four individuals did not feel quetiapine had any benefit, and another 7 were unable to tolerate quetiapine because of side effects. The quetiapine dose used ranged from 25 to 600 mg/day (mean +/- SD dose = 206 +/- 122 mg/day).


CONCLUSIONS
Quetiapine use during opioid cessation was found to help abate symptoms of opioid withdrawal in our patient population and was generally well tolerated.
Pinkofsky
Harold B
HB
Addiction Medicine Services, Center for Psychiatric and Chemical Dependency Services, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. pinkofskyhb@upmc.edu
Hahn
Ann M
AM
Campbell
Frances A
FA
Rueda
John
J
Daley
Dennis C
DC
Douaihy
Antoine B
AB
D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016739:Behavior, Addictive / Q000517:prevention & control / Q000523:psychology / Q000534:rehabilitation; D003987:Dibenzothiazepines / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000523:psychology / Q000534:rehabilitation*; D011785:Quality Assurance, Health Care / Q000379:methods; D000069348:Quetiapine Fumarate; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D000069348:Quetiapine Fumarate