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8. Substance dependence

8.1 Alcohol dependence

Alcohol dependence Preparations Comments
The drugs listed below are for the acute/initial management of alcohol dependence and withdrawal. For longer term management and relapse prevention service users should be referred to CDAT service run by CRI.
Chlordiazepoxide 5mg capsules or tablets  See chlordiazepoxide for alcohol withdrawal regime
Thiamine 50mg and 100mg tablets  
Vitamin B Co strong Tablets  
High potency vitamin B complex (Pabrinex) IM injection For in-patient use.
Facilities for treating anaphylaxis (including resuscitation facilities should be available when parenteral thiamine is administered.

 8.2 Nicotine dependence

 Nicotine dependence Preparations Comments
Nicotine

Transdermal patch: Nicorette® Inivsi Patches 25mg, 15mg and 10mg
Lozenges:NiQuitin® Minis Lozenges 1.5mg and 4mg
Inhalation vapour: Nicorette® Inhalator 15mg cartridges

Orodispersible film (strips): NiQuitin® 2.5mg oral film

Sublingual tablet: Nicorette® Microtab 2mg

Nasal spray:  Nicorette®  500 microgram per actuation

Mouth spray: Nicorette® Quickmist 1mg per actuation

See Nicotine Replacement Therapy Guidelines for Inpatients
Varenicline tartrate 500microgram and 1mg tablet.

NICE -TA123 - Varenicline for smoking cessation

Clinicians should be aware of the possible emergence of serious neuropsychiatric symptoms in patients attempting to quit smoking with or without treatment. Smoking cessation, with or without pharmacotherapy, has been associated with exacerbation of underlying psychiatric illness (e.g. depression). Care should be taken with patients with a history of psychiatric illness and patients should be advised accordingly.

 8.3 Opioid dependence

Opioid dependence Preparations Comments
Treatment of opioid dependence usually requires specialist intervention - generalists who do not have specialist experience should contact CDAT services before attempting to treat opioid dependence.
NICE -TA114 - Methadone and buprenorphine for the management of opioid dependence
Buprenorphine hydrochloride 400microgram, 2mg and 8mg sublingual tablets CD. Only in accordance with specialist recommendations.
Methadone hydrochloride 1mg/ml SF oral solution CD. Only in accordance with specialist recommendations.

 

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