II. Indications
- Opioid Withdrawal in adults age >=18 years
III. Mechanism
- Released in 2018
- Central Alpha-2 Adrenergic Agonist
- Similar to Clonidine
- Lofexidine is more specific to Alpha-2a receptor (less hypotensive effect)
- Decreases Norepinephrine release
- Decreases sympathetic tone
- Decreases symptoms associated with Opioid Withdrawal
- Diarrhea
- Vomiting
- Abdominal Cramping
- Myalgias and Muscle spasms
- Malaise
- Anxiety
- Palpitations
- Insomnia
IV. Dosing
- Start
- Three 0.18 mg tablets four times daily
- Titrate dose to symptoms
- Maximum
- Daily Maximum: 2.88 mg/day
- Dose Maximum: 0.72 mg (four 0.18 mg tablets)
- Duration up to 7-14 days
- Decreased dose indications
- Hepatic insufficiency
- Renal Insufficiency
V. Adverse Effects
- Somnolence (42%)
- Dizziness (29%)
- Hypotension (18%)
- Bradycardia (3%)
- Rebound Hypertension
- Titrate off over 2-4 days
- Serious adverse effects (2.3%)
VI. Cost
- Daily cost: $330/day (compare with Clonidine is at most, $1/day)
VII. References
- (2018) Presc Lett 25(9): 54
- Johns and Lovecchio (2018) Crit Dec Emerg Med 32(10): 24
- Bryce (2019) Am Fam Physician 99(6): 393-4 [PubMed]
- Doughty (2019) Ann Pharmacother 53(7):746-53 +PMID:30724094 [PubMed]
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