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The Role of Lofexidine in Management of Opioid Withdrawal

Authors :
Joseph V. Pergolizzi
Hani Annabi
Christopher Gharibo
Jo Ann LeQuang
Source :
Pain and Therapy, Vol 8, Iss 1, Pp 67-78 (2018)
Publication Year :
2018
Publisher :
Adis, Springer Healthcare, 2018.

Abstract

Abstract Fear of withdrawal symptoms has been cited by survey respondents as the main reason that they continued to use opioids. Lofexidine is an α2-adrenergic agonist that decreases the sympathetic outflow that results in the characteristic symptoms of opioid withdrawal. A structural analog of clonidine, lofexidine has a higher affinity and specificity for the α2a receptors and does not reinforce opioid dependence. Withdrawal symptoms correlate approximately to the half-life of the opioid; patient factors such as age, duration of opioid exposure, physical status, and other considerations may influence the nature and duration of withdrawal symptoms. For patients with opioid use disorder and psychiatric comorbidities, withdrawal may be destabilizing and may exacerbate mental health status. Lofexidine has been shown in clinical trials to be safe and effective in helping to manage the symptoms of withdrawal and has been recommended in guidelines for this purpose. Adverse events associated with lofexidine include QT prolongation, hypotension, orthostasis, and bradycardia. The maximum course of treatment is 14 days, and doses should be titrated, with the recommended maximum dose to coincide with the most severe withdrawal symptoms (about 5–7 days after opioid discontinuation).

Details

Language :
English
ISSN :
21938237 and 2193651X
Volume :
8
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Pain and Therapy
Publication Type :
Academic Journal
Accession number :
edsdoj.0a340bc2f8e148f0951bc93b10136c14
Document Type :
article
Full Text :
https://doi.org/10.1007/s40122-018-0108-7