7-Day Lofexidine Taper Regimen
I cannot provide a 7-day lofexidine taper schedule because lofexidine is not tapered—it is administered at therapeutic doses during opioid withdrawal and then discontinued abruptly after withdrawal symptoms resolve. 1
Standard Lofexidine Treatment Protocol
The FDA-approved regimen involves 5-7 days of fixed-dose lofexidine treatment followed by abrupt discontinuation, not a gradual taper. 1
Days 1-5: Active Treatment Phase
- Administer 0.54 mg four times daily (total 2.16 mg/day) or 0.72 mg four times daily (total 2.88 mg/day) during the acute opioid withdrawal period 1
- The 2.88 mg total daily dose showed slightly better efficacy in reducing withdrawal symptoms (mean SOWS-Gossop score 6.1 vs 6.5 for the lower dose) 1
- Doses should be spaced approximately 5-6 hours apart 1
Days 6-7: Placebo Transition
- Switch to placebo for 2 days after completing 5 days of active lofexidine treatment 1
- This abrupt transition was well-tolerated in FDA registration trials without requiring dose tapering 1
Extended Treatment (If Needed)
- Some patients may require up to 14 days of lofexidine at variable doses (not exceeding 2.88 mg/day), but no patient should receive lofexidine for more than 14 days 1
- After completing treatment, lofexidine is discontinued without tapering 1
Alternative Low-Dose Approach for Medically Directed Opioid Tapering
For patients undergoing gradual outpatient opioid tapering (not acute withdrawal), a low-dose regimen of 0.18 mg every 6 hours has been used successfully for approximately 14 days. 2
- This approach differs fundamentally from acute withdrawal management and involves concurrent opioid dose reduction over 15 days (median) 2
- The lofexidine is discontinued when the opioid taper is complete, again without requiring a taper 2
Critical Monitoring Points
- Monitor blood pressure and heart rate before each dose, as hypotension and bradycardia are the primary safety concerns 1, 3
- Withdrawal symptoms typically peak on days 2-3 and should improve by day 5-7 3
- If symptoms resolve earlier, lofexidine can be discontinued before day 7 without tapering—29% of patients in one series stopped early due to symptom resolution 4
Why Lofexidine Doesn't Require Tapering
Unlike benzodiazepines or antipsychotics, lofexidine is an alpha-2 adrenergic agonist used for short-term symptom management during opioid withdrawal 5. It does not cause physical dependence requiring gradual discontinuation, and abrupt cessation after 5-14 days of use has been demonstrated as safe and standard practice in multiple clinical trials 1, 3, 6.