Drugs that can be used in opioid withdrawal?

Ans. d (All of the above) (Ref. KDT, 6th/pg. 459, 464)OPIOID WITHDRAWALDefinitionClinical syndrome produced by withdrawal of an opioid drug from an opioid-dependent individual, by: (1) the cessation or abrupt reduction in dosage of an opioid; or (2) the administration of an opioid antagonist including naloxone, naltrexone, and nalorphine.Clinical DiagnosisInitial symptoms and signs may develop immediately after the administration of an opioid antagonist or up to 48 hours after cessation or reduction in dosage of the opioid, depending upon the half-life of the drug concerned. These include restlessness, mydriasis, lacrimation, rhinorrhea, sneezing, piloerection, yawning, perspiration, restless sleep and aggres-sive behavior.Severe manifestations include: muscle spasms, backaches, abdominal cramps, hot and cold flushes, insomnia, nausea, vomiting, diarrhea, tachypnoea, hypertension, hypotension, tachycardia, bradycardia and cardiac dysrhythmias. Seizures may be observed in neonates (only).Serum electrolytes (Na, K, Cl), creatinine, blood glucose and hematocrit may be of value in managing.TreatmentOne of two general approaches is commonly adopted.# The first comprises substitution of the drug with a longer-acting opioid, such as methadone, followed by a gradual reduction in dosage of the substitute drug.# The second comprises use of various pharmacological agents, such as clonidine and/or a benzodiazapine, which will mitigate symptoms and signs of withdrawal.# Clonidine suppresses sympathetic overactivity of opioid withdrawal and reduces craving to some extent. The dosage of clonidine should then be gradually reduced, typically over a one- to two-week period.# If symptoms and signs of opioid withdrawal do not respond to the use of clonidine and/or benzodiazepines, then the use of propantheline (for stomach cramps) or atropine (for diarrhea) may be considered.# Opioid-dependent individuals with co-existent medical or surgical conditions requiring pain relief should receive conventional treatment, including if necessary the administration of opioids.Nalaxone can reverse most of the actions of morphine very effectively & completely except SEDATION