Helper Medications

This is a reference, not a prescription. Each of these requires a doctor. The Telehealth Providers comparison lists telehealth options that will work with you on adjuncts.

Quick reference

What helps which symptom, with the doses you’ll typically see prescribed.

Most are non-controlled and most prescribers handle them readily. Bring the table to the visit, describe the symptoms hitting you hardest, and a prescriber familiar with opioid withdrawal will pick from it. Most people benefit from 2–4 of these, not all of them.

The rest of this page walks through each one in more detail, plus a few that don’t fit cleanly in the table (sleep alternatives, post-acute antidepressants, the benzo conversation).

Why these in particular

The compounds covered here (7-OH and the kratom synthetics) act on opioid receptors and also on serotonin, adrenergic, GABA, and other receptor systems. Kratom’s minor alkaloids bind 5-HT₁ₐ, 5-HT₂ᵦ, α-1, and α-2 receptors directly as agonists or antagonists (Obeng et al., J Med Chem 2020), so withdrawal hits multiple systems at once. Suboxone (if you’re using it) covers the opioid side. The medications below cover everything else.

Clonidine

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 evidence going back decades. Non-controlled, decades of safety data, addresses the actual mechanism rather than masking symptoms.

Helps with: sweating, tachycardia, hot/cold flashes, runny nose/eyes, anxiety, restlessness, mild insomnia, abdominal cramps.

Dosing: 0.1 to 0.2 mg orally every 6 to 8 hours, 2–4 times daily. Average treatment is 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.

Lofexidine (Lucemyra) is a newer alpha-2 agonist (FDA-approved specifically for opioid withdrawal in 2018) with similar effects to clonidine but less blood pressure drop. Same family, same idea, expensive and not always covered.

Guanfacine (Tenex, Intuniv) is another alpha-2 agonist, more selective for the alpha-2A receptor than clonidine. Longer-acting (especially the extended-release form), less sedating, less of a blood-pressure drop. On-label for ADHD and hypertension, not formally studied for opioid withdrawal, but mechanistically similar and reached for when clonidine’s short half-life or sedation is a problem.

Propranolol is a beta-blocker rather than an alpha-2 agonist. Different mechanism, overlapping symptom coverage: it blocks the heart-rate spike, tremor, and physical-anxiety side of the sympathetic surge. Typical dose 10–40 mg as needed. Useful when clonidine isn’t tolerated or isn’t enough on its own, often layered with clonidine rather than substituted for it. Doesn’t cover sweating, GI symptoms, or insomnia — a narrower scope than clonidine. Caution in asthma (non-selective beta-blockade can trigger bronchospasm).

Gabapentin (and pregabalin)

GABA analog that calms nervous system overactivity. Useful for the wired, anxious, can’t-sleep cluster that bupe and clonidine don’t fully cover.

Helps with: anxiety, restless legs, insomnia, brain zaps, muscle/nerve pain, the SSRI-discontinuation-style feeling.

Dosing: start at 100–300 mg, titrate up to 1,800–2,100 mg/day in divided doses. Most prescribers start low and let you find your dose.

Side effects: sedation, dizziness, mild euphoria at higher doses (one reason some prescribers are cautious), weight gain with chronic use.

Gabapentin has its own withdrawal if used long-term and stopped abruptly. Taper off when you’re done with it. Don’t combine with alcohol, opioids, or benzos without medical supervision; the combination carries overdose risk.

Pregabalin (Lyrica) is similar but more potent, faster-acting, and has a higher abuse profile. Less commonly prescribed in this context but works for the same symptoms.

Provider attitudes vary. Some hand gabapentin out readily; others want you more established before adding it. The Telehealth Providers comparison flags which platforms have worked for adjuncts.

Veterinary gabapentin (no prescription needed)

Gabapentin sold for dogs and cats is the same molecule as the human drug. There is no animal-specific version of it. Some veterinary pharmacies ship it in sealed manufacturer packaging, in the standard strengths (100, 300, 600, and 800 mg) and the same capsules and tablets a regular pharmacy hands out. For people who can’t get a prescriber to add gabapentin, or who want to skip the appointment, this is a route the community uses.

A few specifics:

• Choose plain capsules or tablets over flavored liquid. Compounded veterinary suspensions can carry unknown fillers and inconsistent strength. Sealed manufacturer capsules and tablets are a known quantity.
• The dosing and cautions above apply unchanged. Start low, titrate, and taper when you’re done. Don’t stack gabapentin with opioids, benzodiazepines, or alcohol without medical supervision; the combination slows breathing and carries overdose risk.
• Legality varies by state. Gabapentin isn’t federally controlled, but several U.S. states schedule it or track it through prescription-monitoring programs. Buying it for personal use is off-label, and the decision is yours.
• A prescriber is still the simplest path. Gabapentin is one of the medications telehealth platforms add most readily (Telehealth Providers); the veterinary route is for when that isn’t an option.

Two vendors that ship manufacturer-packaged gabapentin for animal use:

Dog & Cat Stuff — gabapentin in 100- and 500-count bottles, 100/300/600/800 mg, capsules and tablets.

Pet Pharm Canada — the same manufacturer-packaged strengths and bottle sizes.

Baclofen and muscle relaxants

Baclofen is a GABA-B receptor agonist used for muscle spasticity. In withdrawal it helps with muscle aches, restless legs, and body tension, and some studies suggest it may also reduce post-acute cravings.

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).

Other muscle relaxants:

• 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 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, useful for muscle pain without much “drugged” feeling.
• Magnesium glycinate (OTC, see Vitamins & Supplements) covers some of the same territory. Some people don’t need a prescription muscle relaxer if magnesium is on board.

Sleep medications

Insomnia is often the worst part of withdrawal, and sleep matters more than people realize for recovery.

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. As a first-generation antihistamine it can worsen restless legs. If you have RLS, skip it 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 covers a lot at once. A 2023 review proposed it as a one-stop strategy for opioid withdrawal because it addresses nausea, vomiting, anxiety, insomnia, and depression in a single med. Non-addictive. Ask your prescriber if several of those symptoms are stacking up together.

Z-drugs (zolpidem/Ambien, eszopiclone/Lunesta) are sometimes prescribed but carry their own dependence risk. Most MAT prescribers prefer trazodone first.

Melatonin (OTC, low dose 0.3–1 mg) helps reset a disrupted circadian rhythm. Not strong enough on its own for severe withdrawal insomnia, useful in combination.

Diphenhydramine (Benadryl) is widely available OTC for sleep but, like hydroxyzine, worsens restless legs. Skip it during withdrawal if RLS is on your symptom list.

Anti-nausea

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 if nausea is keeping you awake. It’s a first-generation antihistamine that can worsen restless legs, and the injectable form carries an FDA black box warning. The oral version is fine for most people; 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 (for diarrhea)

Diarrhea during withdrawal is one of the most dehydrating symptoms. Loperamide is OTC, effective, and fine at labeled doses.

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

Withdrawal often brings diarrhea, but plenty of people hit the reverse, either before quitting (opioids are constipating by nature) or as things swing back during recovery. Opioid-induced constipation is miserable and worth treating proactively rather than waiting out.

The two most effective tools are cheap and over the counter:

Docusate sodium (Colace), a stool softener. 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. Draws water into the bowel and is one of the most effective and best-tolerated options available without a prescription. Safe for daily use. This usually does the heavy lifting.

Using them together is a reasonable approach: docusate to keep stool soft, PEG 3350 to get things moving. Both are inexpensive, widely available, and non-habit-forming.

Stronger prescription options (lubiprostone, linaclotide, or the PAMORA class, peripherally-acting opioid antagonists like methylnaltrexone or naloxegol) specifically target opioid-induced constipation. Ask a prescriber about those if OTC isn’t cutting it. For most people the cheap OTC combination above is a major quality-of-life improvement on its own.

General tips: stay hydrated (especially 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; the docusate + PEG combo is gentler for daily use.

OTC for body aches

• NSAIDs (ibuprofen, naproxen): body aches, headaches. OTC, useful, easy on the system at normal doses. 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.

Bupropion (Wellbutrin), for post-acute

Bupropion is a norepinephrine-dopamine reuptake inhibitor that addresses the dopamine and norepinephrine deficits behind anhedonia and low motivation in PAWS. For the broader picture on those symptoms, see Depression and Anhedonia.

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.

Helps with (post-acute): low motivation, anhedonia, mood, low energy, smoking cessation if that’s also relevant.

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 and 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.

GABA-A receptor agonists, immediate effect on anxiety, muscle tension, and sleep. The effect is dramatic and reliable.

Trade-offs:

• 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 combination carries genuine 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.
• Telehealth restrictions on Schedule IV controlled substances make benzos harder to prescribe via telehealth even when a provider is willing.

Sometimes a short course (1–2 weeks max) for severe acute withdrawal under close supervision is prescribed. Not as maintenance.

Alternatives: clonidine + gabapentin + hydroxyzine or trazodone cover most of what people want benzos for. Less dramatic moment-to-moment, compatible with the rest of recovery.

Telehealth Suboxone providers will almost universally decline a benzo request on top of the regulatory restrictions. Asking will slow the visit down without changing the answer.

Where to get these

Most are non-controlled and easy to prescribe. The Telehealth Providers comparison covers options that work with kratom/7-OH cases. Standard primary care doctors will prescribe most of these readily.

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 familiar with addiction is the right specialist.

Common starter combos

• Acute withdrawal basics: clonidine + ondansetron + ibuprofen + trazodone
• Add for restless or anxious presentation: gabapentin
• Add for muscle pain: baclofen or tizanidine
• Add for post-acute mood: bupropion (after the acute phase ends)

Helper meds pair with any of the community-documented quitting paths: cold turkey, tapering with leaf, Suboxone, or SR-17. See Vitamins & Supplements for the supplement side, and What is PAWS for the longer-term picture.