| Mitigation of opioid withdrawal symptoms during abrupt opioid discontinuation (label). View labelExact | The usual starting dosage is three 0.18 mg tablets (0.54 mg) four times daily during peak withdrawal symptoms, with 5 to 6 hours between doses (label). | Central α2-adrenergic agonist used to mitigate opioid withdrawal symptoms (autonomic hyperactivity, anxiety, GI distress) during abrupt opioid discontinuation; does not treat opioid use disorder itself and does not reduce relapse risk without follow-on care (label/guideline). | CYP2D6 (primary contributor), CYP1A2, CYP2C19 | Single-dose range 11–13 h; Steady-state range 17–22 h | No | | - Monitor blood pressure and pulse before dosing and in symptomatic patients; adjust/hold dosing for clinically significant hypotension or bradycardia (label/clinical).
- Consider ECG monitoring when QT risk factors are present (electrolyte abnormalities, heart failure, bradyarrhythmias, hepatic/renal impairment, or concurrent QT-prolonging drugs such as methadone) (label).
- Review sedation, dizziness, and fall risk; reinforce a taper plan to reduce rebound symptoms at discontinuation (label/clinical).
| No | 2026-02-12 |
|---|
| Hypertension (label). Psychiatric uses are typically off-label (formulation- and population-dependent). View labelExact | Hypertension labeling commonly starts at 0.1 mg twice daily (morning and bedtime) (label). | Alpha-2 adrenergic agonist; reduces central sympathetic outflow (antihypertensive; also used off-label in psychiatry). | Hepatic metabolism (multiple pathways) | Single-dose range 12–16 h | No | | - Baseline and periodic blood pressure and heart rate, especially during titration or dose changes.
- Orthostasis, dizziness, and sedation; adjust dosing timing and review interacting medications if symptoms emerge.
- Renal impairment and medication adherence; missed doses can trigger rebound hypertension in some patients.
- Discontinuation plan documented in advance to reduce rebound hypertension and agitation risk.
| No | 2025-12-30 |
|---|
| Opioid use disorder treatment (induction; selected maintenance scenarios) (label). View labelExact | Buprenorphine sublingual tablets are administered sublingually as a single daily dose (label).
For short-acting opioids, the label recommends administering the first dose only when objective and clear signs of moderate opioid withdrawal are present and not less than 4 hours after the last opioid use (label). | Partial μ-opioid receptor agonist used for opioid use disorder (OUD) treatment; reduces withdrawal and cravings and is commonly used for induction, with transition to buprenorphine/naloxone preferred for unsupervised maintenance when appropriate (label/guideline). | CYP3A4 (N-dealkylation to norbuprenorphine), UGT (glucuronidation of buprenorphine and norbuprenorphine) | Single-dose range 31–35 h | No | | - Confirm objective withdrawal prior to induction to reduce precipitated withdrawal risk; document the induction plan and follow-up schedule (label/clinical).
- Monitor sedation and respiratory risk, especially when alcohol, benzodiazepines, or other sedatives are present; opioid overdose education and naloxone access planning are common (label/clinical).
- Track cravings, ongoing opioid use, and functional outcomes; adjust the treatment plan if goals are not being achieved (label/clinical).
- Monitor for oral/dental adverse effects and reinforce rinsing/oral hygiene practices recommended in labeling (label/clinical).
| No | 2025-12-31 |
|---|
methadoneAdjunctive therapyBrands: Methadose, Dolophine | Opioid use disorder maintenance in certified opioid treatment programs and analgesia (label varies by product). View labelExact | Opioid use disorder (OUD) dosing is typically managed within an opioid treatment program, with dose changes guided by withdrawal control, cravings, and safety (guideline/clinical).
Because accumulation risk is highest early in treatment, many programs avoid rapid escalation and reassess frequently after dose changes (label/clinical). | Long-acting full μ-opioid receptor agonist used for opioid use disorder maintenance (in regulated opioid treatment programs) and for analgesia. Long and variable half-life can lead to accumulation and overdose risk if titration is too rapid (label/guideline). | CYP2B6, CYP3A4, Other CYP enzymes (variable; label) | Single-dose range 8–59 h | No | | - Monitor sedation and respiratory status during initiation and after dose increases; reassess concurrent sedatives and polysubstance use risk (label/clinical).
- QTc planning: consider ECG monitoring when cardiac risk factors, high doses, or QT-active co-medications are present (label/clinical).
- Monitor for constipation and other opioid adverse effects that can affect adherence and quality of life (clinical).
- Reassess withdrawal control and cravings and adjust treatment supports (housing, therapy, peer support) when available (guideline/clinical).
| No | 2026-02-22 |
|---|