This increase was more in clonidine group with a significant difference compared with dextromethorphan and clonidine group versus. After 72 Hours from Admission. The severity of withdrawal symptoms was significantly more in clonidine group compared with dextromethorphan and clonidine group versus.
The used drugs in this study were those used as routine agents in different diseases and had no side effects in used doses. This study shows that dextromethorphan added to clonidine regimen has a better efficacy compared to clonidine alone in controlling the mild withdrawal symptoms in male opioid addicts. In the patients receiving clonidine alone the withdrawal symptoms increased across the study and reached their most severity after 72 hours from admission, while patients who received dextromethorphan and clonidine experienced milder symptoms.
Their symptoms decreased after a peak in 48 hours from admission. The alpha-2 agonists such as clonidine may decrease the withdrawal symptoms by controlling the excess activity of the adrenergic system [ 11 ].
Clonidine is being used in the treatment of withdrawal syndrome since [ 12 — 14 ] and a majority of detoxification regimens are using it [ 15 ], but its effectiveness is not optimal when used alone. Hyperstimulation of these receptors in events such as strokes, head trauma, and convulsive attacks would result in neuronal death while their decreased activity would result in schizophrenic status [ 11 ].
Kukanich and Pabich report that dextromethorphan is a noncompetitive antagonist of NMDA receptors that is used as an antitussive, adjuvant analgesic, alcohol, and opioid withdrawal symptom reducer [ 16 ]. It is also used in clinical trials combined with morphine resulting an increased analgesic effect [ 11 ]. The fact that NMDA antagonists may relieve some withdrawal symptoms is a sign of association between glutaminergic and opioid neurotransmitter systems.
NMDA-antagonists would reduce the effects of opioids withdrawal on basal forebrain and amygdale, but they do not affect the locus cerelous. Moreover it seems that NMDA-antagonists would result in a delay in developing tolerance to opioid. Another support comes from the study by Zhu et al. The role of NMDA-antagonists in opioid withdrawal relief is also described for another medication from this group, memantine, which decreased the symptoms of withdrawal in heroin-addict patients [ 18 ].
A single-blind study by Bisaga et al. Authors suggested that it may shorten the detoxification period compared to methadone [ 19 ]. These results are confirmed by the present double-blind study as well. In a similar study , it was demonstrated that memantine solely is effective in the reduction of subjective symptoms of withdrawal syndrome and the authors recommended that memantine may be used as an adjuvant therapy in the reduction of withdrawal symptoms [ 20 ].
Simultaneously there have been efforts to increase the bioavailability of dextromethorphan as well. A group of opioid dependence patients were treated with a combination of dextromethorphan and quinidine, aiming to decrease the metabolism of dextromethorphan and dextrophan level Quinidine inhibits the metabolism of dextromethorphan, leading to reduce of dextromethorphan metabolite, dextrorphan, levels [ 21 ].
Authors found that this combination was ineffective in reducing the withdrawal symptoms compared to placebo and most of the patients left the study in six days due to the severity of symptoms. In the study by Bisaga et al. This may be explained by metabolic differences of the study sample. This study had some limitations. The study sample consisted of patients who had decided to undertake detoxification treatment.
This may decrease generalization of the results as they were highly motivated and this could influence their subjective complaints in part. However the objective symptoms could still measure their symptoms to a good extent.
The double blind setting increased the accuracy as well. This study could not include a placebo group like most of the studies in this field. Dextromethorphan, as a NMDA antagonist, is effective in the relief of withdrawal symptoms. Hence it is very useful in increasing the efficacy of clonidine and reducing the need for opioid agonists. Added dextromethorphan to clonidine resulted in symptom reduction as soon as the second day of admission while patients experienced very few side effects.
The authors would like to thank all subjects participating in this study. This study was supported by grants from the Tabriz University of Medical Sciences. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles. Academic Editor: H. Received 09 May Accepted 11 Jun Published 20 Jun Abstract Background. Introduction Addiction is one of the most disturbing and problematic social phenomena in current years with known social, economic, and individual detriments.
Materials and Methods This study was performed as a double-blind randomized clinical trial in Razi Hospital, Tabriz, Iran. Results Thirty patients completed the trial in each group.
Clonidine group Clonidine and Dextromethorphan group value Number of patients 30 30 — Initial symptoms score 0. Table 1. Figure 1. Severity of withdrawal symptoms in patients randomized to receive clonidine or clonidine and dextromethorphan measured at admission, 24, 48, and 72 hours later. References A.
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If you think you may have a medical emergency, call your doctor, go to the emergency department, or call immediately. Dextromethorphan and Opioid Addiction The recommended dose of DXM is between 10 and 20 mg every 4 to 6 hours, or 30 mg every 6 to 8 hours. DXM and Opioid Withdrawal One clinical trial conducted in found that dextromethorphan had the potential to relieve symptoms associated with opioid withdrawal.
Studies on Dextromethorphan and Opioid Detox Another study conducted by the American Journal on Addictions and the American Academy of Psychiatrists in Alcoholism and Addictions found that a combination of dextromethorphan and quinidine was highly effective in treating the more severe symptoms associated with heroin detoxification.
Ready to Rebuild Your Life? For Confidential Help, Call:. Our data support the efficacy of low-dose dextromethorphan in treating opioid-dependent patients on MMT. Low-dose dextromethorphan might be a feasible adjuvant therapy for decreasing concomitant opioid use, mitigating opioid withdrawal symptoms, and attenuating inflammation.
Trial registration is NCT J Psychopharmacol 21 : — Google Scholar. Drug Alcohol Depend 59 : 1 — Am J Psych : Neuromol Med 5 : 69 — Glia 56 : — Br J Pharmacol : — Brain Res : — Biol Psychiatry 69 : e — Drug Alcohol Depend 67 : — J Chem Neuroanat 37 : 65 — Endicott J Spitzer RL A diagnostic interview: the schedule for affective disorders and schizophrenia. Arch Gen Psychiatry 35 : — J Addict Med 7 : — Immunol Lett : 22 — Nat Neurosci 10 : — Houghtling RA Bayer BM Rapid elevation of plasma interleukin-6 by morphine is dependent on autonomic stimulation of adrenal gland.
J Pharm Exp Ther : — Inflammation 24 : — Kleber HD Pharmacologic treatments for opioid dependence: detoxification and maintenance options. Dialogues Clin Neurosci 9 : — Kleber HD et al. American Psychiatric Association.
Am J Psych : 5 — J Am Board Fam Med 21 : 45 — J Clin Psychopharmacol — Liu B Hong JS Primary rat mesencephalic neuron-glia, neuron-enriched, microglia-enriched, and astroglia-enriched cultures. Methods Mol Med 79 : — Am J Geriatr Pharmacother 3 : 17 — J Psychopharmacol 12 : 15 — Adv Drug Deliv Rev 36 : — Ann Neurol 39 : — Chao CC Morphine amplifies HIV-1 expression in chronically infected promonocytes cocultured with human brain cells.
J Neuroimmunol 50 : — J Clin Psychiatry 59 Supp 20 : 22 — Part 2: Opioid dependence. World J Biol Psychiatry 12 : — Pharmacology 50 : 51 — PLOS Med 3 : e J Neurochem : — Mov Disord 13 : — J Biomed Sci 16 : Biometrics 44 : — J Physiol Pharmacol 51 : — Oxford University Press is a department of the University of Oxford.
It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Statement of Interest. Oxford Academic. Shiou-Lan Chen, PhD. Yun-Hsuan Chang, PhD. Chun-Hsien Chu, PhD. Shih-Heng Chen, PhD. Nian-Sheng Tzeng, MD. I Hui Lee, MD.
Yen Kuang Yang, MD. Jau-Shyong Hong, PhD. Ru-Band Lu, MD. Revision received:. Select Format Select format. Permissions Icon Permissions. Abstract Background:. Open in new tab Download slide. Table 1. Open in new tab. Table 2. Methadone dose required 1 2.
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