Case report: acute care management of severe opioid withdrawal with IV fentanyl

Table 2 Dosage regimen

Admission Timeline	Hydromorphone (IV)	Fentanyl (IV)			Monitoring
Admission Timeline	Doses	Order	Dose	Cumulative daily	RASS (COWS)
Day 1	100 mg refused
	100 mg
	100 mg
Day 2	100 mg refused
	100 mg refused
		100–200 mcg q5 min prn (induction)	200 mcg		0 (17)
			200 mcg		0
			200 mcg		0
			200 mcg	800 mcg	0 (2)
Day 3		300–400 mcg q1h prn (maintenance; consolidation)*	5 × 400 mcg	2000 mcg	− 1/0
Day 4			4 × 400 mcg; 1 × 300 mcg	1900 mcg	− 1/0
Day 5			3 × 400 mcg; 4 × 300 mcg	2400 mcg	− 1/0
Day 6			6 × 400 mcg	2400 mcg	− 1/0
Day 7			7 × 400 mcg	2800 mcg	− 1/0
Day 8			4 × 400 mcg	1600 mcg	− 1/0

q_mins: every_minutes; q_h: every_hour; prn: as needed; IV: intravenous; RASS: Richmond Agitation-Sedation Scale; COWS: Clinical Opiate Withdrawal Score; mg: milligram; mcg: microgram
^*Patient self-selected for 300–400 mcg IV fentanyl every 3–4 h as it provided adequate sedation, pain relief and opioid effect

ISSN: 1940-0640