two days, he was put on inj. pethidine. 100 mg twice a day, inj. diazepam. 10 mg twice daily and a hypnotic at bed time. Patient developed severe withdrawal.
Indian J. Psychiat. (1981), 23(4), 375—376 CLONIDINE F O R OPIATE WITHDRAWAL
SUBRAMANYA1, M.B.B.S. S. M.
CHANNABASAVANN.V,
The abstinence syndrome which follows withdrawal of opiates is the prototype of drug withdrawal reaction a n d is one of the several factors promoting addiction. Although m a n a g e m e n t of this syndrome is but a small p a r t of treatment of an a d d i c t , it is nonetheless a n important one. Recent studies have shown that a single dose of Clonidine hydrochloi ide ( A R K A M I N ) relieves signs a n d symptoms of opiate withdrawal a n d that addicts can be successfully detoxified with Clonidine. T h e rationale for testing Glonidine's efficacy in opiate withdrawal was based on animal studies showing that increased brain noradrenergic activity associated with opiate withdrawal was markedly reduced by Clonidine (Washton et ah, 1980). Recently, we have successfully treated a case of opiate withdrawal with Clonidine. T h e case is being reported to demonstrate Clonidine's efficacy in treating opiate abstinence syndrome with particular relevence to our country where M e t h a d o n e is r.ot available. The Case : Mr. V , a 32 year old married H i n d u male was brought to our O P D on M a y 25, 1981, for treaiment of Morphine addiction. H e first took Morphine injection seven years ago, when h e met with a small accident. T h e patient reported that he h a d a very pleasant experience with that injection, a n d reported for daily injections. The 'Junior Resident in Psychiatry 'Professor of Psychiatry & Medical Superintendent
M.D., D.P.M.
physician readily agreed. Within 3 m o n t h s , he became an addict and without M o r p h i n e injections he could not function. His intake of Morphine gradually increased to 5-10 ampules per d a y . Meanwhile, he started consuming d i a z e p a m a n d alcohol in large quanti'ies. H e was unsuccessfully treated at a n u m b e r of facilities. T h e patient was a d m i t t e d a n d M o r phine was completely discontinued from the day of hospitalization. For the first two days, he was put on inj. pethidine 100 mg twice a day, inj. diazepam 10 mg twice daily and a hypnotic a t bed t i m e . Patient developed severe withdrawal symptoms in the form of irritability, sleeplessness, lethargy, chills, rhinorrhoea, restlessness, abdominal cramps, nausea and diarrhoea. F r o m the third d a y of hospitalization, he was started on t a b . Clonidine 0.1 m g 6 hourly (all other drugs were stopped). T h e dose of Clonidine was increased by one tablet everyday u p t o a m a x i m u m of 0.9 m g per d a y . Regular checku p of blood pressure was d o n e a n d the p a t i e n t did not develop any postural hypotension. Paiicnt showed remarkable improvement on the veiy next d a y of starling Clonidine, a n d he became asymptomatic within 5 days. Patient was maintained on a dose of 0.9 m g of Clonidine per day for the next 10 days. O v e r the next 5 days, dose of Clonidine was reduced a t the rate of 2 tablets per d a y . Patient became drug free on 20th d a y of t r e a t m e n t a n d h e was totally asymptomatic National Institute of Mental Health & Neuro Sciences, Bangalore-560 029.
SUBRAMANYA AND S. M. CHANNABASAVANNA
376
at that time. Patient was kept in the hospital for the next 5 days without any drugs and later he was discharged. DISCUSSION Clonidine (available in India as ARK.AMIN 0.1 mg tablets) is an effective drug in controlling opiate withdrawal symptoms. Several studies suggest that Clonidine may be superior to Methadone in controlling morphine abstinence syndrome (Gold elal., 1980; Washton et al., 1980). In order
Grams:
to achieve a safe and effective control of withdrawal symptoms with Clonidine, the dose regimen must be individualized according to each patient's blood pressure and symptomatology. REFERENCES GOLD et al. (1980). Clonidine & Opiate Withdrawal. Lancet, 1078. WASHTON et al. (1980). Clonidine fur Opiate Detoxification—Outpatient Clinical Trial. American J. Psychiat., 137, 9, 1121.
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