Tapentadol and Zolpidem addiction management with Ayurvedic intervention: A case report

Opioids pose significant challenges worldwide. Tapentadol's unrestrained availability has raised concerns, as it is developing as an alternative for illicit pharmaceutical opioids. A case of 31-year-old patient complaining of anxiousness, profuse perspiration, body ache, lacrimation, restlessness, sleeplessness, and loose stools with history of Tapentadol and zolpidem abuse showed in the OPD on Oct 31, 2023. The patient's Clinical opiate withdrawal scale (COWS) evaluated withdrawal symptoms of the as moderate (score 28) and the Insomnia Severity Index (ISI) showed the severe insomnia (score 25). Patient was prescribed with tapering dose of Sameergajakesari Rasa (375, 250, 125mg), Vishatindukadi Vati 250mg, Combination of Sitopaladi Churna 3g + Lakshmivilas Rasa 250mg + Tankan Bhasma 250 mg, over 3 weeks, Combination of Vaatvidhwansank Ras 250mg + Godanti Bhasma 250mg + Tryodshang Gugglu 500mg for first 2 weeks, Ksheerpaka of Ashwagandha Churna 3g + Shatavari Churna 2g + Gokshur Churna 1g and Brahmarasayan 5g for third week. Externally Dashmoola Tail Sarvanga Abhyanga, Sarvanga Swedana, Shirodhara with Til Taila and Brahmi Tail, Pranayama, Yoga and counselling. The total COWS score decreased from 28 prior to treatment to 2 after three weeks of treatment. Similarly, ISI score decreased from 25 to zero after treatment. The patient was treated solely using Ayurvedic treatment, including Satvajaya Chikitsa, and no complications were noticed during the course of treatment. Observations suggested that with the Ayurvedic management, withdrawals and insomnia were completely resolved within three weeks of treatment. The baseline investigations were normal, and the patient continued to practice yoga and counselling during and after therapy, abstaining for 60 days post treatment.