Alternative to zofran in heroin withdrawal

[peiyueng]

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Just started my shadow day at my psych residency. It appears that the standard cocktail here for an 5150 person coming off heroin is Zofran+ Clonidine (or Klonopin) + PRN IM antipsychotic.

I don't like using expensive meds. I would like to use prochloperazine (Compazine) instead of zofran. However, I wanted to have some ammunition to justify this to the attendings.

To me, not only is prochlorperazine cheaper, its structure is similar to the antipsychotics. Therefore, it has some mild antipsychotic effects. So, I would think that this would be a perfect choice since nearly all the inpt population have some form of PRN antipsychotic on standby (IM olanzapine, for example or IM Geodone).

Anyone with experience of using prochlorperazing or other less expensive alternatives such as droperidol in prophylaxing against heroin withdrawal?

Any input would be appreciated.

cheers.

 

[IAmAUser]

.

 

[billypilgrim37]

Usually whatever the common practice is around your parts has something to do with whatever the best deal was your pharmacy was able to make with its manufacturers. We use Tigan. I still know nothing about this drug other than it's the one we use. Checkbox, no puke.

 

[whopper]

I used dicyclomine, and from my own anectdotal experience it was a heck of a lot more effective than the typical stuff that is used to treat GI related symptoms from opioid withdrawal. It's also cheap.

It is not, however, FDA approved for GI problems from opioid withdrawal. Use your own judgment.

 

[TheWowEffect]

Phenergan...and/or Morphine for significant opioid withdrawal until they are seen in person by MD..Then taper Morphine and start Suboxone if they are motivated and they or their insurance can pay for it.

 

[nitemagi]

Phenergan, zofran, reglan.

Even used haldol a few times for nausea in other circumstances.

 

[BobA]

I use compazine. It's available in suppository (which is safer than IV) if they can't take PO.