Detox Protocols

Green Oaks Standard Detox Orders

I. MANAGEMENT

Notify attending physician if HR > 120, SBP > 170 or DBP > 100
Vital signs q4 hours while awake x24h then q6h x 2days, then daily qAM
Thiamine 100 mg IM now
Thiamine 50 mg PO daily
Folic Acid 1 mg PO daily
MVI PO daily

II. MEDICATIONS FOR ALCOHOL DETOX WITH LIBRIUM

(Hold if patient intoxicated, sedated, or asleep)
Admit/Day1: Librium 50 mg PO now and q6h x24h
Day 2: Librium 50 mg PO TID
Day 3: Librium 25 mg PO QID
Day 4: Librium 25 mg PO BID
Day 5: Librium 25 mg PO qhs
Librium 50 mg PO q2h prn signs or sx of etoh withdrawal, not to exceed 400 mg in 24 hours (review after 72 hours)

III. MEDICATIONS FOR ALCOHOL DETOX WITH ATIVAN

(Hold if patient intoxicated, sedated, or asleep)
Admit/Day 1: Ativan 2 mg PO now and q6h x24h
Day 2: Ativan 1 mg PO TID
Day 3: Ativan 0.5 mg PO QID
Day 4: Ativan 0.5 mg PO BID
Day 5: Ativan 0.5 mg PO qhs
Ativan 2 mg PO q2h prn signs or sx of etoh withdrawal, not to exceed 10 mg in 24 hours (review after 72 hours)

IV: MEDICATIONS FOR OPIOID DETOX

(Hold clonidine is pulse < 60 or SBP < 100)
Admit/Day 1: Clonidine 0.1 mg PO now and q6h x24h
Day 2: Clonidine 0.1 mg PO TID
Day 3: Clonidine 0.1 mg PO BID
Day 4: Clonidine 0.1 mg PO BID
Day 5: Clonidine 0.1 mg PO qhs
Clonidine 0.1 mg PO q4h prn signs or sx of opioid withdrawal
Robaxin 1500 mg q6h prn moderate to severe muscle cramps, not to exceed 6000 mg in 24h
Bentyl 20 mg PO q4h prn stomach cramps not to exceed 160 mg in 24 hours
Imodium 4 mg PO after first loose stool followed by 2 mg PO after each loose stool, not to exceed 16 mg in 24 hours
Motrin 600 mg PO q6h for mild muscle cramps, not to exceed 3200 mg in 24h
Klonopin 0.5 mg PO q4h prn for anxiety, agitation, restlessness, insomnia
Phenergran 25 mg PO or IM q6h prn nausea

Opiate and Alcohol Withdrawal Orders (Dr. Wakhlu, VA Gold)

Alcohol Withdrawal

Librium 50mg po q6 hours prn EtOH withdrawal x 72 hours,
then Librium 50mg po q8 hours prn EtOH withdrawal for 48 hours,
then Librium 25mg po q 8 hours prn EtOH withdrawal for 48 hours,
then 25 mg po q 12 hours prn EtOH withdrawal for 24 hours,
then d/c.

Alcohol Withdrawal Protocols (Outpatient appropriate Patients)

Gabapentin

300mg | 300mg | 600mg x72hrs
300mg | 300mg | 300mg x48hrs
300mg | | 300mg x48hrs
300mg x24-48hrs

Carbamazepine

200mg QID x72hrs
200mg TID x 48hrs
200mg BID x48hrs
200mg QDay x 24hrs

Withdrawal

Librium 50mg po q 6 hours, then taper gradually depending on clinical response
Clonidine Patch 0.2mg/24 hours (weekly patch) . Hold if P < 60, systolic BP < 90 or DBP < 60.
Flexeril 10-20mg po TID
Trazodone 100mg po at bedtime prn for insomnia
Kaopectate for diarrhea
Bentyl 10mg po BID prn for abdominal cramps

Objective symptoms of withdrawal

At most sites you must write out the objective sx of withdrawal for prns. For example: SBP > 160, DBP > 100, P > 110, T > 100, tremor, diaphoresis, agitation, or anxiety

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