Jump to content

Withdrawal Symptoms in Elderly Patient


Recommended Posts

This question was posted on pcssNOW.org:

Frail elder female suddenly self-stopped chronic use (200 mg/day for 9 years) of tramadol x 3 weeks ago. How long will withdrawal symptoms last? Still experiencing soaking cold sweats 3-4x/day, difficulty sitting still, anxiety, difficulty sleeping, difficulty voiding. Any safe suggestions to treat the sweats? Clonidine and Lucemyra have been discussed but not good options for patient. Very remote area here. thank you.

  • Upvote 1
Link to post
Share on other sites

 I would expect that the worst phase of mu-opioid withdrawal has passed and it appears the patient has entered a more chronic, protracted withdrawal phase. Protracted withdrawal could persist for several more weeks or even months, especially the sleep disturbance. Age and possible co-morbidities can limit use of ancillary withdrawal medication, as you’ve alluded to with clonidine and Lucemyra, which is unfortunate as these medications might help with sleep as well as diaphoresis. Other medications to target anxiety and insomnia from opioid withdrawal can also have undesirable adverse effects in an elderly patient and might not address the diaphoresis.  Moving beyond the mu-opioid component of withdrawal, tramadol also has serotonin-norepinephrine reuptake inhibitor properties.  Several patients who I’ve transitioned from tramadol to buprenorphine experienced residual symptoms that seemed to overlap with an SNRI discontinuation syndrome (e.g., headache, insomnia, “brain zaps”) more so than from inadequate opioid coverage. For most of these patients, the symptoms lasted a few days to a week. For a couple patients, the symptoms were alleviated by a dose or two of low dose duloxetine. Of note, these cases are anecdotal, which needs to be taken into consideration when assessing benefit/risk. 

  • Like 2
  • Upvote 1
Link to post
Share on other sites

Join the conversation

You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

×
×
  • Create New...