Medical Treatment: Mild withdrawal
Can be done outpatiently. Symptomatic treatment
* Diazepam, oral, at divided doses of 5- 20 mg per day.
For stomach cramps:
* Hyoscin butylbromide, oral, 20 mg up to 8 hours per hour.
* Loperamide, oral, immediately 4 mg for diarrhoea.
Moderate to severe withdrawal
- After every loose stool, o 2 mg.
- Maximum dose at 24 hours: 16 mg.
Patient hospitalization.Substitution treatment
In the specialist rehabilitation centre, methadone syrup should be used.
Day 1: only when there are clinical signs of withdrawal:
* Methadone, oral, 10 mg
- Give a further 5-10 mg if symptoms are still present after 1 hour.
- After 12 hours, the initial dose to suppress withdrawal symptoms may be repeated.
- Rarely should the total 24-hour dose exceed 30 mg.
Day 2: Repeat day 1 total dose as one or two divided doses.
Day 3: Decrease by 5 mg per day to 10 mg in total. Diminish by 2 mg / day. If the withdrawal symptoms of the patient allow it, the withdrawal regime can be shortened.