⚠️ This is a reference, not a prescription. All of these require a doctor. #quickmd-info has telehealth options. #helper-meds is the chat channel for discussing your experiences with these meds.
The compounds we deal with here (7-OH and the synthetics) hit your opioid receptors and the noradrenergic, serotonergic, GABA, and other systems via the SNRI-like activity of kratom’s minor alkaloids. Suboxone covers the opioid side. Helper meds cover everything else.
This post organizes them by what they do, not by what they’re “officially” prescribed for. You don’t need every one of these. Most people benefit from 2-4. A skilled prescriber will help you figure out which ones fit your symptoms.
Clonidine (the workhorse)
An alpha-2 adrenergic agonist that blocks the noradrenergic surge driving most physical withdrawal symptoms. It’s the most widely-used non-opioid withdrawal medication, with robust evidence going back decades.
What it helps: sweating, tachycardia, hot/cold flashes, runny nose/eyes, anxiety, restlessness, mild insomnia, abdominal cramps.
Typical dosing: 0.1 to 0.2 mg orally every 6 to 8 hours, often dosed 2-4 times daily. Average treatment duration about 15 days for acute withdrawal, then taper off.
Side effects: sedation, dry mouth, low blood pressure, dizziness on standing. Hold the dose if blood pressure drops below 90/60.
Why prescribers like it: non-controlled, non-addictive, decades of safety data, hits the actual mechanism (sympathetic overdrive) rather than just masking symptoms.
Lofexidine is a newer alpha-2 agonist (FDA-approved specifically for opioid withdrawal in 2018) with similar effects but less blood pressure drop. Same family, same idea, but expensive and not always covered.
Anti-nausea (antiemetics)
Nausea and vomiting are common during withdrawal and dehydrating. Don’t tough it out.
Ondansetron (Zofran) is usually first-line. 5-HT3 receptor antagonist, well-tolerated, available as an orally-disintegrating tablet. Typical dose: 4 mg every 8 hours as needed. Some research suggests ondansetron may reduce overall withdrawal severity, not just nausea. Side effects are mild (occasional headache, constipation).
Promethazine (Phenergan) is older but effective, with the bonus of significant sedation, useful if nausea is keeping you awake. Caveat: it’s a first-gen antihistamine that can worsen restless legs, and it carries an FDA black box warning for the injectable form. The oral version is fine for most people, but if you have RLS symptoms, ondansetron is the better choice.
Metoclopramide (Reglan) and prochlorperazine (Compazine) are alternatives if the first two don’t work. All four are non-controlled and easy to prescribe.
For mild nausea, ginger tea, peppermint, or OTC Pepto-Bismol may be enough.
Loperamide (Imodium) for diarrhea
Diarrhea during withdrawal is one of the most dehydrating symptoms. Loperamide is OTC, effective, and fine at labeled doses.
Critical warning: loperamide is itself a peripheral mu-opioid agonist. At normal doses it doesn’t cross the blood-brain barrier meaningfully. At very high doses it does, can cause cardiac arrhythmias, and is dangerous. Don’t be tempted to megadose it for “bonus” effects. Use as labeled.
For combined diarrhea + cramps, bismuth subsalicylate (Pepto-Bismol) works well and is gentler on the GI tract.
Constipation — the opposite GI problem
Withdrawal often brings diarrhea, but a lot of people hit the reverse, either before quitting (opioids are constipating by nature) or as things swing back during recovery. Opioid-induced constipation is genuinely miserable and worth treating proactively rather than waiting it out.
The good news: the two most effective tools are cheap and over the counter.
Docusate sodium (Colace) — a stool softener. It pulls water into the stool so things move more comfortably. Gentle, non-stimulant, safe to take daily. Good as a baseline if you know constipation is coming.
Polyethylene glycol 3350 (MiraLAX) — an osmotic laxative. It draws water into the bowel and is one of the most effective and best-tolerated options available without a prescription. Safe for daily use. Most people find this does the heavy lifting.
Using them together is a reasonable approach: docusate to keep stool soft, PEG 3350 to actually get things moving. Both are inexpensive, widely available, and non-habit-forming.
Stronger prescription options exist — things like lubiprostone, linaclotide, or the PAMORA class (peripherally-acting opioid antagonists like methylnaltrexone or naloxegol) that specifically target opioid-induced constipation. If the OTC route isn’t cutting it, those are worth asking a prescriber about. But for most people, the cheap OTC combination above is a massive quality-of-life improvement on its own.
General tips: stay hydrated (especially important if you’re also doing vitamin C megadosing or sweating through withdrawal), keep some fiber and movement in your routine, and don’t lean hard on stimulant laxatives (senna, bisacodyl) long-term — they’re fine occasionally but the docusate + PEG combo is gentler for daily use.
Gabapentin (and pregabalin)
GABA analog that calms nervous system overactivity. Genuinely useful for the wired/anxious/can’t-sleep cluster that bupe and clonidine don’t fully cover.
What it helps: anxiety, restless legs, insomnia, brain zaps, muscle/nerve pain, the SNRI-discontinuation feeling.
Typical dosing: start at 100-300 mg, titrate up to 1,800-2,100 mg/day in divided doses. Most prescribers start lower and let you find your dose.
Side effects: sedation, dizziness, mild euphoria at higher doses (which is also why some prescribers are cautious), weight gain with chronic use.
Important note: gabapentin has its own withdrawal if used long-term and stopped abruptly. Taper off when you’re done with it. Do not combine with alcohol, opioids, or benzos without medical supervision; the combination has overdose risk.
Pregabalin (Lyrica) is similar but more potent, faster-acting, and has a higher abuse profile. Less commonly prescribed in MAT contexts but works for the same symptoms.
Provider attitudes vary. Some prescribers hand it out readily; others want you more established before adding it. #quickmd-info has notes on advocating for this.
Baclofen and muscle relaxants
Baclofen is a GABA-B receptor agonist used for muscle spasticity. In withdrawal contexts it helps with the muscle aches, restless legs, body tension, and (per some studies) may reduce cravings post-acute too.
Typical dosing: 5 mg three times daily, can increase to 40 mg/day total. Some prescribers continue baclofen post-acute for craving reduction.
Side effects: sedation, fatigue, occasional confusion at higher doses. Taper off when discontinuing, abrupt stops can cause hallucinations and seizures (rare but real).
Other muscle relaxants worth knowing about:
- Tizanidine (Zanaflex) — alpha-2 agonist (similar mechanism to clonidine), helps muscle spasms and anxiety. Useful when clonidine isn’t enough. Sedating.
- Cyclobenzaprine (Flexeril) — short-term muscle relaxant, helpful for the body-aches part of withdrawal. Often only prescribed for 1-2 weeks. Sedating.
- Methocarbamol (Robaxin) — older muscle relaxant, less sedating than the others, helpful for muscle pain without much “drugged” feeling.
- Magnesium glycinate (OTC supplement, see #vitamins-supplements) is a real adjunct here too. Some people don’t need a prescription muscle relaxer if magnesium is on board.
Sleep medications
Insomnia is often the worst part of withdrawal. Sleep matters more than people realize for recovery, so this is an area worth optimizing.
Trazodone is the most prescribed sleep med in MAT contexts. Non-addictive, non-controlled, helps both falling asleep and staying asleep. Typical dose: 50-150 mg at bedtime. Side effects: morning grogginess, occasional priapism (rare but if it happens, stop and see a doctor).
Hydroxyzine (Atarax/Vistaril) is a non-controlled antihistamine for anxiety and sleep. Caveat: as a first-gen antihistamine, it can worsen restless legs. If you have RLS, skip this and use trazodone or doxepin instead.
Doxepin at low doses (3-6 mg) is FDA-approved for insomnia. Tricyclic antidepressant chemistry but at sleep doses it’s mostly antihistaminic. Useful when trazodone doesn’t work.
Mirtazapine (Remeron) at 7.5-15 mg deserves its own callout. A 2023 review proposed it as a “one-stop strategy” for opioid withdrawal because it covers nausea, vomiting, anxiety, insomnia, and depression simultaneously. Single med, multiple symptoms covered, non-addictive. Worth asking your prescriber about.
Z-drugs (zolpidem/Ambien, eszopiclone/Lunesta) are sometimes prescribed but have their own dependence risk. Most MAT prescribers prefer trazodone first.
Melatonin (OTC, low dose 0.3-1 mg) helps reset disrupted circadian rhythm. Not strong enough on its own for severe withdrawal insomnia but useful in combination.
Wellbutrin (bupropion) — for after, mostly
Bupropion is a norepinephrine-dopamine reuptake inhibitor. It directly addresses the dopamine and norepinephrine deficits that cause anhedonia and low motivation in PAWS.
The catch: it’s not great during active withdrawal. The stimulating effect can worsen anxiety and insomnia in the acute phase, and it takes 4-6 weeks to reach full effect anyway. Most prescribers add it 2-4 weeks into recovery when the worst is over and PAWS-style anhedonia is settling in.
What it helps (post-acute): low motivation, anhedonia, mood, low energy, smoking cessation if that’s also relevant.
Typical dosing: 150 mg/day to start, titrate to 300 mg/day. SR or XL formulations preferred for steady levels.
Don’t take if: seizure history, eating disorder, currently on MAOIs.
SSRIs/SNRIs
If your post-acute period includes significant depression or anxiety that isn’t lifting, full antidepressants are reasonable. They take 4-6 weeks to work and aren’t useful for acute withdrawal. Drug interaction caution: combining with 5-HTP, L-tryptophan, St. John’s Wort, or tramadol risks serotonin syndrome.
Buspirone
Non-addictive anxiety medication that hits 5-HT1A receptors. Slow onset (1-2 weeks to effect), no sedation, no dependence. Useful for ongoing anxiety post-acute. Typical dose: 5-10 mg 2-3 times daily.
Benzodiazepines
Benzos (Xanax, Klonopin, Valium, Ativan, Librium) are highly effective for the anxiety, insomnia, and muscle tension of opioid withdrawal. They’re also why most MAT prescribers won’t touch them in this context.
Why they work: GABA-A receptor agonists, immediate effect on anxiety, muscle tension, sleep. The effect is dramatic and reliable.
Why prescribers say no:
- Benzo + opioid combinations significantly increase overdose risk. Most opioid overdose deaths involve a benzo or alcohol on board. If you’re on bupe and add a benzo, the combo carries real risk.
- Cross-tolerance with alcohol. People with substance use history are statistically more likely to develop benzo dependence.
- Benzo withdrawal is significantly worse than opioid withdrawal. It’s medically dangerous (seizure risk) and lasts much longer. Trading one dependence for another is a real concern.
- Telehealth restrictions make them harder to prescribe via platforms like QuickMD even when a provider is willing.
When they do get prescribed: sometimes a short course (1-2 weeks max) for severe acute withdrawal under close supervision. Not as a maintenance medication.
The realistic alternatives: clonidine + gabapentin + hydroxyzine or trazodone covers most of what people want benzos for, without the dependence risk. The combo is less dramatic moment-to-moment but doesn’t trade one problem for another.
Don’t ask your QuickMD provider for benzos. It will slow the visit down and won’t change the answer.
Other meds worth knowing about
- NSAIDs (ibuprofen, naproxen) — body aches, headaches. OTC, useful, gentle on the system. Don’t overdo it (kidney/stomach impact).
- Acetaminophen (Tylenol) — body aches without GI issues. Watch the daily limit.
- Aspirin — older but works for body aches. Some prescribers prefer it for the anti-inflammatory effect.
- Diphenhydramine (Benadryl) — Avoid, known to cause RLS..
- Tizanidine — already mentioned under muscle relaxants but worth highlighting again as an alternative when clonidine alone isn’t covering you.
How to get these
Most are non-controlled and easy to prescribe. #quickmd-info covers telehealth options. Standard primary care doctors will prescribe most of these readily; bring research if needed.
For MAT contexts (Suboxone), your bupe prescriber is usually the right person to add helper meds to your protocol. They already know your situation.
For chronic anxiety or depression that needs long-term treatment, a psychiatrist or therapist who understands addiction is the right specialist.
Bottom line
Helper meds are real tools, not extras. The right combination genuinely changes how survivable withdrawal feels. Most people benefit from 2-4 of these, not 8.
Common starter combos:
- Acute withdrawal basics: clonidine + ondansetron + ibuprofen + trazodone
- Adding for restless/anxious presentation: plus gabapentin
- Adding for muscle pain: plus baclofen or tizanidine
- Adding for post-acute mood: Wellbutrin (after the acute phase ends)
See #vitamins-supplements for the supplement side, #what-is-paws for the longer-term picture, and post in #helper-meds to ask about specific protocols and share what worked.