Brief Answer:
please tell me the last dose and time and composition of syrup

Detailed Answer:
Hello and welcome to health care magic!

I have gone through your query and it says that you take codiene based cough syrup from 15ys and presently take 2.5bottle daily. Now you want to quit it.

For deaddiction purpose I would like to know -

1. what is the exact amount of various components present in that syrup bottle?

2. The various complaints you face during withdrawal and what is the most troublesome for you? Like for most of the people it is calf muscle cramps and sleep problem. So, what is your most improtant complaint?

If there is a patient taking opioid comes to my clinic for deaddiction, I usually take help of pain killer, sleeping pills , electrol replenishing drinks, multi vitamins and clonidine in various doses (according to the age of the patient/ dose of substance being abused/his general profile).

Also, it is very important for me to know - why do you fail each time you want to quit?

Because, deaddiciton in itself is an easy thing (matter of few days to may be two weeks at maximum) to do but, to remain deaddicted for life is the real challenge and that is what is most important part.

Please tell me when have you taken the last dose of syrup?

Kindly provide me the details of the above questions so that I can guide you accordingly.

Wish you good luck!

Dr. Manisha Gopal
MD Neuropsychiatry

---

Brief Answer:
I give clonidine , pantoperazole, diclofenac , chlordiazepoxide

Detailed Answer:
Hello

Thanks for writing back.

Willingness to quit is the most important step towards a drug free life...

I would like to tell you in the begening itself that in case of chronic abuse the deaddiction is best done after admission in a hospital under medical supervision.

Or atleast under daily monitoring by a psychiatrist by visiting him or her for checkup.

When such patient visits me for deaddiction I usually start with advising clonidine 0.1mg thrice to four times a day after checking his blood pressure. This drug is avoided if blood pressure falls below 90/60mm Hg.
The clonidine is taken for two days like this and then reduced to twiec a day. And further dose depends upon the status of the patient. So you can discuss the same after two days again.

Patient is asked to take lots of liquid to maintain electrolyte balance. It can be juice, ORS, electrol etc.

Along with this I start a pain killer like diclofenac or declofenac paracetamol combination twice to thrice a day.

Many times a sleeping pill is also needed, I prefer chlordiazepoxide 25mg thrice or twice a day. At night one may take additional if needed.

We dont recommend anything specific for loose stools as they stop on their own after second or third day of stopping drug. But in severe cases loperamide may be needed.

For gastric irritation and acidity- pantoperazole is used and a multi vitamin is given daily.

So, please get your blood pressure checked during the treatment phase.
Take adequate rest and dont take the codeine syrup.

With medicines 60-70% of the problem of withdrawal is over commed but rest the patient has to bear. It is just the matter of few days and then the person is drug free.

So, I advice the person to bear some pain and have courage and patience for these days.

P.S. One should not drive or operate a risky machinery druring withdrawal phase of drug.

I hope the reply is useful for you.
Please ask if there is any more query.

Wish you good health.
Dr. Manisha Gopal
MD Neuropsychiatry

---

Brief Answer:
if restlessness is present in daytime take chlordiazepoxide

Detailed Answer:
Hello,

Thankyou for writing back.

Sir, usually it is seen that during the withdrawal phase the patient complaints of severe anxiety in daytime. So, taking a sleeping pill (or an anti anxiety pill) helps to handle the same.
I suggest my patients to take half or one tablet of chlordiazepoxide in daytime. Its is advisable not to drive on those days.

However, if there are no complaints of anxiety or restlessnes during the day time, dose of this can be skipped.

There are many good brand multivitamins are available now. I prefer giving something that has a good quantity of vit B12 in it along with other vitamins. Medicines like rejunex OD, or nervic OD etc. Can be taken.

I hope the reply is informative for you. Please feel free to ask more queries if there are any doubts.

Dr. Manisha Gopal
MD Neuropsychiatry

---