A 35 year old male came to the psychiatry OPD with complains of rhinorrhoea, back pain, loose stools, lacrimation and tremulousness for last 2 days. History revealed that it's a case of Opioid Dependence Syndrome currently in withdrawal state. We don't have Buprenorphine + Naloxone tablets easily available and hence we started to manage him with Clonidine 300ugm tablets in divided doses which has been carefully tapered slowly over next 10 -14 days to counteract his sympathetic overdrive. He was also prescribed Tramadol tabs SOS for pain, loperamide tabs SOS for loose stools and Lorazepam Tabs for sedation.
The patient refused admission and hence it was a tedious task to manage such thing in OPD basis. This pt returned after 3 days with head reeling, BP recorded was 84/56 mm Hg. Opioid Withdrawal symptoms are still present and his relatives confirmed that he has been strictly off opioid…
