From the Guidelines
Lofexidine is primarily used to manage opioid withdrawal symptoms as an alpha-2 adrenergic agonist medication. The medication works by reducing the release of norepinephrine in the brain, which helps alleviate many withdrawal symptoms like anxiety, agitation, muscle aches, sweating, and runny nose 1.
Key Points About Lofexidine Use
- The typical dosing regimen begins at 0.18 mg taken orally four times daily, with the possibility of increasing to a maximum of 2.88 mg per day (0.72 mg four times daily) 1.
- Treatment duration is usually 5-7 days, coinciding with the acute withdrawal period.
- Common side effects include hypotension, bradycardia, dizziness, and sedation, so blood pressure and heart rate monitoring is recommended during treatment.
- Lofexidine should be tapered rather than abruptly discontinued to prevent rebound hypertension.
Comparison and Advantage
Lofexidine offers an advantage over clonidine, a similar medication sometimes used off-label, because lofexidine is FDA-approved specifically for opioid withdrawal and may cause less hypotension 1. While not addressing cravings directly, lofexidine can be used as part of a comprehensive treatment plan that may include counseling and potentially transition to maintenance medications like buprenorphine or methadone for long-term opioid use disorder management.
Clinical Considerations
In clinical practice, it's essential to consider the patient's overall health status, potential for drug interactions, and the need for close monitoring of blood pressure and heart rate during lofexidine treatment 1. The goal is to alleviate withdrawal symptoms effectively while minimizing risks and ensuring a smooth transition to long-term management strategies for opioid use disorder.
From the FDA Drug Label
Lofexidine tablets are a central alpha-2 adrenergic agonist indicated for mitigation of opioid withdrawal symptoms to facilitate abrupt opioid discontinuation in adults. The use of Lofexidine is for mitigation of opioid withdrawal symptoms to facilitate abrupt opioid discontinuation in adults.
- The medication is a central alpha-2 adrenergic agonist.
- It is used to help manage opioid withdrawal symptoms.
- The goal of using Lofexidine is to facilitate abrupt opioid discontinuation in adults 2.
From the Research
Use of Lofexidine
- Lofexidine is an alpha-2 adrenergic receptor agonist used for the treatment of opioid withdrawal symptoms 3, 4, 5, 6, 7
- It has been shown to be effective in reducing opioid withdrawal symptoms with less reported hypotension than clonidine 3, 5, 6
- Lofexidine has been approved in the United Kingdom for the treatment of opioid withdrawal symptoms 3, 5
Efficacy of Lofexidine
- Studies have demonstrated that lofexidine significantly decreases mean withdrawal scores compared to placebo 3, 5
- Lofexidine has been shown to have better retention rates in patients undergoing opioid withdrawal compared to placebo 3, 5
- It has been reported to be well tolerated in clinical trials with adverse events including QT prolongation, hypotension, orthostasis, and bradycardia 4
Clinical Use of Lofexidine
- Lofexidine can be used as a non-opioid alternative to treat opioid withdrawal symptoms 3
- The maximum course of treatment is 14 days, and doses should be titrated to coincide with the most severe withdrawal symptoms 4
- Lofexidine has been successfully incorporated into conventional withdrawal management protocols in inpatient addiction treatment facilities 7