Methadone at tapered doses for the management of opioid withdrawal.


BACKGROUND:Despite use in many countries of tapered methadone for detoxification from opiate, the evidence of efficacy to prevent relapse and promote lifestyle change has not been systematically evaluated. OBJECTIVES:To determine whether tapered methadone is effective to manage withdrawal from opioids. SEARCH STRATEGY:We searched: Cochrane Controlled Trial Register (Issue 1, 2000), MEDLINE (OVID 1966-2000), EMBASE (1980-2000); reference list of relevant articles; personal communication; conference abstracts; trials from pharmaceutical industry; Internet. SELECTION CRITERIA:All randomised controlled trials on the use of tapered methadone versus all other detoxification treatments, placebo and different modalities of methadone detoxification programs for the treatment of opiate withdrawal. DATA COLLECTION AND ANALYSIS:One reviewer assessed studies for inclusion and undertook data extraction. The overall process were confirmed by consultation between reviewers. MAIN RESULTS:20 studies were included, with 1357 people randomised. 10 studies compared methadone with adrenergic agonists, 7 compared different modalities of methadone detoxification, 2 compared methadone with other opioid agonists, 1 study compared methadone with chlordiazepoxide one with placebo. 10 studies that compared methadone with adrenergic agonists showed clinical differences of the treatments; 6 studies that compared different methadone schedules, showed different withdrawal responses; 2 studies that compared methadone and other opioid agonists showed that methadyl acetate performed similarly to methadone, while propoxyphene produced more severe withdrawal symptoms and more drop-outs than methadone; chlordiazepoxide and methadone (1 study) resulted similar in terms of overall effectiveness; more severe withdrawal and more drop outs in the placebo group than in methadone one (1 study). The results indicate that tapered methadone and other medications used are effective although symptoms experienced differed according to the medication used and the program adopted. The medications are similar in terms of overall effectiveness. Improvements were achieved when other services supporting services were offered contemporaneously with detoxification. REVIEWER'S CONCLUSIONS:Data from literature are hardly comparable; programs vary widely with regard to duration, design and treatment objectives, along with reporting impairing the application of meta-analysis. The studies included confirm that slow tapering with temporary substitution of long acting opioid can reduce withdrawal severity. Nevertheless the majority of patients relapsed to heroin use, abstinence cannot be considered a goal as heroin dependence is a chronic, relapsing disorder and the purpose of detoxification should be to remove or reduce dependence on heroin in a controlled and human fashion and not a treatment for heroin dependence.


Amato L,Davoli M,Ferri M,Ali R





Has Abstract


2002-01-01 00:00:00










  • Pentoxifylline for endometriosis.

    abstract:BACKGROUND:Endometriosis is a chronic, recurring condition that occurs during the reproductive years. It is characterized by endometrial tissue developing outside the uterine cavity. This endometrial tissue development is dependent on oestrogen produced primarily by the ovaries and, therefore, traditional management ha...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Lu D,Song H,Li Y,Clarke J,Shi G

    更新日期:2012-01-18 00:00:00

  • Supplemental oxygen for the treatment of prethreshold retinopathy of prematurity.

    abstract:BACKGROUND:Oxygen has long been implicated in the pathogenesis of retinopathy of prematurity (ROP) and is rigorously monitored in today's neonatal intensive care units. Recent research using a feline model has shown an improvement in ROP outcome of kittens treated with supplemental oxygen. Current treatment for ROP by ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Lloyd J,Askie L,Smith J,Tarnow-Mordi W

    更新日期:2003-01-01 00:00:00

  • Epinephrine for bronchiolitis.

    abstract:BACKGROUND:Bronchodilators are commonly used for acute bronchiolitis, despite uncertain effectiveness. OBJECTIVES:To examine the efficacy and safety of epinephrine in children less than two with acute viral bronchiolitis. SEARCH STRATEGY:We searched CENTRAL (2010, Issue 3) which contains the Acute Respiratory Infecti...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Hartling L,Bialy LM,Vandermeer B,Tjosvold L,Johnson DW,Plint AC,Klassen TP,Patel H,Fernandes RM

    更新日期:2011-06-15 00:00:00

  • Polyclonal and monoclonal antibodies for treating acute rejection episodes in kidney transplant recipients.

    abstract:BACKGROUND:Registry data shows that between 15-35% kidney recipients will undergo treatment for at least one episode of acute rejection within the first post transplant year. Treatment options include pulsed steroid therapy, the use of an antibody preparation, the alteration of background immunosuppression, or combinat...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Webster A,Pankhurst T,Rinaldi F,Chapman JR,Craig JC

    更新日期:2006-04-19 00:00:00

  • Ultrasound use for the placement of haemodialysis catheters.

    abstract:BACKGROUND:A significant proportion of patients starting dialysis do so with a temporary or tunnelled haemodialysis catheter. Insertion of these catheters can be achieved either by using the anatomical landmarks for the veins into which they are inserted or using ultrasound guidance. It has been suggested that the use ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Rabindranath KS,Kumar E,Shail R,Vaux EC

    更新日期:2011-11-09 00:00:00

  • Patient-controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour.

    abstract:BACKGROUND:Multiple analgesic strategies for pain relief during labour are available. Recently remifentanil, a short-acting opioid, has recently been used as an alternative analgesic due to its unique pharmacological properties. OBJECTIVES:To systematically assess the effectiveness of remifentanil intravenous patient-...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Weibel S,Jelting Y,Afshari A,Pace NL,Eberhart LH,Jokinen J,Artmann T,Kranke P

    更新日期:2017-04-13 00:00:00

  • Cognitive behavioural therapy plus standard care versus standard care plus other psychosocial treatments for people with schizophrenia.

    abstract:BACKGROUND:Cognitive behavioural therapy (CBT) is a psychosocial treatment that aims to help individuals re-evaluate their appraisals of their experiences that can affect their level of distress and problematic behaviour. CBT is now recommended by the National Institute for Health and Care Excellence (NICE) as an add-o...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析


    authors: Jones C,Hacker D,Meaden A,Cormac I,Irving CB,Xia J,Zhao S,Shi C,Chen J

    更新日期:2018-11-15 00:00:00

  • Fluphenazine (oral) versus placebo for schizophrenia.

    abstract:BACKGROUND:Fluphenazine is one of the first drugs to be classed as an 'antipsychotic' and has been widely available for five decades. OBJECTIVES:To compare the effects of oral fluphenazine with placebo for the treatment of schizophrenia. To evaluate any available economic studies and value outcome data. SEARCH METHOD...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Matar HE,Almerie MQ,Sampson SJ

    更新日期:2018-06-12 00:00:00

  • Drug treatment for spinal muscular atrophy types II and III.

    abstract:BACKGROUND:Spinal muscular atrophy (SMA) is caused by degeneration of anterior horn cells, which leads to progressive muscle weakness. Children with SMA type II do not develop the ability to walk without support and have a shortened life expectancy, whereas children with SMA type III develop the ability to walk and hav...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Wadman RI,Bosboom WM,van der Pol WL,van den Berg LH,Wokke JH,Iannaccone ST,Vrancken AF

    更新日期:2012-04-18 00:00:00

  • Pharmacotherapies for sleep disturbances in Alzheimer's disease.

    abstract:BACKGROUND:Sleep disturbances, including reduced nocturnal sleep time, sleep fragmentation, nocturnal wandering and daytime sleepiness are common clinical problems in dementia due to Alzheimer's disease (AD), and are associated with significant caregiver distress, increased healthcare costs and institutionalisation. Dr...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: McCleery J,Cohen DA,Sharpley AL

    更新日期:2014-03-21 00:00:00

  • Topical anaesthetic or vasoconstrictor preparations for flexible fibre-optic nasal pharyngoscopy and laryngoscopy.

    abstract:BACKGROUND:Nasal pharyngolaryngoscopy (NPL) is performed as an outpatient and inpatient procedure on a daily basis, for a variety of indications. It frequently causes some degree of discomfort to the patient. Various different topical agents, which are intended to reduce this discomfort, are in common use. This review ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Sunkaraneni VS,Jones SE

    更新日期:2011-03-16 00:00:00

  • Computer-assisted versus oral-and-written dietary history taking for diabetes mellitus.

    abstract:BACKGROUND:Diabetes is a chronic illness characterised by insulin resistance or deficiency, resulting in elevated glycosylated haemoglobin A1c (HbA1c) levels. Diet and adherence to dietary advice is associated with lower HbA1c levels and control of disease. Dietary history may be an effective clinical tool for diabetes...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Wei I,Pappas Y,Car J,Sheikh A,Majeed A

    更新日期:2011-12-07 00:00:00

  • Ivermectin for onchocercal eye disease (river blindness).

    abstract:BACKGROUND:It is believed that ivermectin (a microfilaricide) could prevent blindness due to onchocerciasis. However, when given to everyone in communities where onchocerciasis is common, the effects of ivermectin on lesions affecting the eye are uncertain and data on whether the drug prevents visual loss is unclear. ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Ejere H,Schwartz E,Wormald R

    更新日期:2001-01-01 00:00:00

  • Laparoscopic versus open gastrectomy for gastric cancer.

    abstract:BACKGROUND:Gastric cancer is the third most common cause of cancer-related mortality in the world. Currently there are two surgical options for potentially curable patients (i.e. people with non-metastatic gastric cancer), laparoscopic and open gastrectomy. However, it is not clear whether one of these options is super...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Best LM,Mughal M,Gurusamy KS

    更新日期:2016-03-31 00:00:00

  • Carbonic anhydrase inhibitors for hypercapnic ventilatory failure in chronic obstructive pulmonary disease.

    abstract:BACKGROUND:Carbonic anhydrase inhibitors such as acetazolamide cause a mild metabolic acidosis and may stimulate breathing. Some patients with severe chronic obstructive pulmonary disease (COPD) develop chronic hypercapnic ventilatory failure. In theory, they may benefit from use of these drugs with a fall in arterial ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Jones PW,Greenstone M

    更新日期:2001-01-01 00:00:00

  • Vitamin supplementation for preventing miscarriage.

    abstract:BACKGROUND:Miscarriage is a common complication of pregnancy that can be caused by a wide range of factors. Poor dietary intake of vitamins has been associated with an increased risk of miscarriage, therefore supplementing women with vitamins either prior to or in early pregnancy may help prevent miscarriage. OBJECTIV...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Balogun OO,da Silva Lopes K,Ota E,Takemoto Y,Rumbold A,Takegata M,Mori R

    更新日期:2016-05-06 00:00:00

  • Interventions for non-oliguric hyperkalaemia in preterm neonates.

    abstract:BACKGROUND:Non-oliguric hyperkalaemia of the newborn is defined as a plasma potassium level > 6.5 mmol/L in the absence of acute renal failure. Hyperkalaemia is a common complication in the first 48 hours of life in very low birth weight (birth weight < 1500 g) and/or very preterm newborns (< 32 weeks gestational age)....

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Vemgal P,Ohlsson A

    更新日期:2007-01-24 00:00:00

  • Rheum officinale (a traditional Chinese medicine) for chronic kidney disease.

    abstract:BACKGROUND:Chronic kidney disease (CKD) is a major public health issue worldwide. Standard therapies to delay CKD progression include dietary protein restriction and administration of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) to help control blood pressure and confer additi...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Wang H,Song H,Yue J,Li J,Hou YB,Deng JL

    更新日期:2012-07-11 00:00:00

  • Hypertonic saline for peri-operative fluid management.

    abstract:BACKGROUND:Fluid excess may place patients undergoing surgery at risk for various complications. Hypertonic saline (HS) maintains intravascular volume with less intravenous fluid than isotonic salt (IS) solutions, but may increase serum sodium. OBJECTIVES:To determine the benefits and harms of HS versus IS solutions a...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: McAlister V,Burns KE,Znajda T,Church B

    更新日期:2010-01-20 00:00:00

  • Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy.

    abstract:BACKGROUND:Cholecystectomy is a common surgical procedure. In the open cholecystectomy area, antibiotic prophylaxis showed beneficial effects, but it is not known if its benefits and harms are similar in laparoscopic cholecystectomy. Some clinical trials suggest that antibiotic prophylaxis may not be necessary in lapar...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Sanabria A,Dominguez LC,Valdivieso E,Gomez G

    更新日期:2010-12-08 00:00:00

  • Elective delivery in diabetic pregnant women.

    abstract:BACKGROUND:In pregnancies complicated by diabetes the major concerns during the third trimester are fetal distress and the potential for birth trauma associated with fetal macrosomia. OBJECTIVES:The objective of this review was to assess the effect of a policy of elective delivery, as compared to expectant management,...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Boulvain M,Stan C,Irion O

    更新日期:2001-01-01 00:00:00

  • Photodynamic therapy for recurrent respiratory papillomatosis.

    abstract:BACKGROUND:Recurrent respiratory papillomatosis (RRP) is a benign condition of the mucosa of the upper aerodigestive tract. It is characterised by recurrent papillomatous lesions and is associated with human papillomavirus (HPV). Frequent recurrence and rapid papilloma growth are common and in part responsible for the ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Lieder A,Khan MK,Lippert BM

    更新日期:2014-06-05 00:00:00

  • Chemoprophylaxis and intermittent treatment for preventing malaria in children.

    abstract:BACKGROUND:Malaria causes repeated illness in children living in endemic areas. Policies of giving antimalarial drugs at regular intervals (prophylaxis or intermittent treatment) are being considered for preschool children. OBJECTIVES:To evaluate chemoprophylaxis and intermittent treatment with antimalarial drugs to p...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Meremikwu MM,Omari AA,Garner P

    更新日期:2005-10-19 00:00:00

  • Physical health care monitoring for people with serious mental illness.

    abstract:BACKGROUND:Current guidance suggests that we should monitor the physical health of people with serious mental illness, and there has been a significant financial investment over recent years to provide this. OBJECTIVES:To assess the effectiveness of physical health monitoring, compared with standard care for people wi...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Tosh G,Clifton AV,Xia J,White MM

    更新日期:2014-01-17 00:00:00

  • Length of hospitalisation for people with severe mental illness.

    abstract:BACKGROUND:In high-income countries, over the last three decades, the length of hospital stays for people with serious mental illness has reduced drastically although considerable variation remains. In lower-income countries this variation may be greater. Some argue that reduction in hospital stay leads to 'revolving d...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Babalola O,Gormez V,Alwan NA,Johnstone P,Sampson S

    更新日期:2014-01-30 00:00:00

  • Antithrombotic agents for preventing thrombosis after infrainguinal arterial bypass surgery.

    abstract:BACKGROUND:Peripheral arterial disease (PAD) is frequently treated by either an infrainguinal autologous (using the patient's own veins) or synthetic graft bypass. The rate of occlusion of the graft after one year is between 12% and 60%. To prevent occlusion, patients are treated with an antiplatelet or antithrombotic ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Geraghty AJ,Welch K

    更新日期:2011-06-15 00:00:00

  • Radical radiotherapy for stage I/II non-small cell lung cancer in patients not sufficiently fit for or declining surgery (medically inoperable).

    abstract:BACKGROUND:In general, surgery is believed to offer the best prospects for cure for early stage non-small cell lung cancer (NSCLC). In spite of the intention to consider all patients with stage I-II disease for surgery, there are those who, although technically operable, either refuse surgery or are considered inoperab...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Rowell NP,Williams CJ

    更新日期:2001-01-01 00:00:00

  • Interferon beta for secondary progressive multiple sclerosis.

    abstract:BACKGROUND:Therapy with either recombinant beta-1a or beta-1b interferons (IFNs) is worldwide approved for Relapsing Remitting Multiple Sclerosis (RRMS). A major unanswered question is whether this treatment is able to safely reverse or retard the progressive phase of the disease. OBJECTIVES:The main objective was to ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: La Mantia L,Vacchi L,Di Pietrantonj C,Ebers G,Rovaris M,Fredrikson S,Filippini G

    更新日期:2012-01-18 00:00:00

  • Oral anticoagulants versus antiplatelet therapy for preventing further vascular events after transient ischaemic attack or minor stroke of presumed arterial origin.

    abstract:BACKGROUND:Patients who are entered in clinical trials after a transient ischaemic attack (TIA) or non disabling ischaemic stroke have an annual risk of important vascular events (death from all vascular causes, non-fatal stroke, or non-fatal myocardial infarction) of between 4 and 11 percent. Aspirin, in a daily dose ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Algra A,de Schryver EL,van Gijn J,Kappelle LJ,Koudstaal PJ

    更新日期:2001-01-01 00:00:00

  • Hypofractionation for clinically localized prostate cancer.

    abstract:BACKGROUND:Using hypofractionation (fewer, larger doses of daily radiation) to treat localized prostate cancer may improve convenience and resource use. For hypofractionation to be feasible, it must be at least as effective for cancer-related outcomes and have comparable toxicity and quality of life outcomes as convent...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章


    authors: Hickey BE,James ML,Daly T,Soh FY,Jeffery M

    更新日期:2019-09-03 00:00:00