China
Africa
Explore chapters and articles related to this topic
Care of opiate users: detoxification
Published in Berry Beaumont, David Haslam, Care of Drug Users in General Practice, 2021
If the patient has been on high doses of methadone for some time it may be more acceptable to employ a few doses of steep methadone reduction in the first few days of the lofexidine protocol. In these circumstances, methadone could be reduced from the previous maintenance dose to zero over five days in even decrements and the lofexidine continued for a few more days. However, it should be remembered that whatever regime is used, coming off years of high-dose methadone over a couple of weeks with lofexidine is going to be uncomfortable.
Pharmacological interventions
Published in Ilana B. Crome, Richard Williams, Roger Bloor, Xenofon Sgouros, Substance Misuse and Young People, 2019
If lofexidine is used to ameliorate opioid withdrawal symptoms, then the prescribing regime may be similar to that used for adults. Indeed, guidance and a local protocol for adults should be available and prescribing usually commences at 0.2–0.4 mg twice a day, increased daily as necessary to control withdrawal, in increments of 0.2–0.8 mg daily to a maximum of 2.4 mg a day. In practice, lower doses are usually recommended for young people due to the increased risk of side effects (e.g., particularly those related to hypotension). Therefore, twice daily monitoring is recommended with brief physical health checks, including blood pressure monitoring.
Psychosocial and pharmacological interventions
Published in G. Hussein Rassool, Alcohol and Drug Misuse, 2017
There are now satisfactory non-opiate treatments (such as lofexidine) for opiate withdrawal. It helps to reduce withdrawal effects such as chills, sweating, stomach cramps, muscle pain, difficulties sleeping and runny nose. In addition, it is less liable to be misused or diverted on to the black market. Lofexidine can be used with supervision in inpatient, residential and community settings. There is evidence to suggest that it is equally as efficacious as methadone in withdrawal and has a role in the treatment of opiate-dependent individuals seeking abstinence and whose drug use is already well controlled. Clonidine is not licensed for the treatment of opiate withdrawal symptoms but is useful as a non-opiate treatment for opiate withdrawal. Because of its substantial hypotensive effect there is a need to monitor blood pressure and to modify or withdraw the treatment if symptomatic hypotension occurs.
Sublingual dexmedetomidine (BXCL501) reduces opioid withdrawal symptoms: findings from a multi-site, phase 1b/2, randomized, double-blind, placebo-controlled trial
Published in The American Journal of Drug and Alcohol Abuse, 2023
Jermaine D. Jones, Lavanya Rajachandran, Frank Yocca, Robert Risinger, Michael De Vivo, Jeff Sabados, Frances R. Levin, Sandra D. Comer
The safety, tolerability, and preliminary efficacy observed in the current trial support the further development of BXCL501 (sublingual dexmedetomidine) in the treatment of opioid withdrawal. Currently, only one medication is FDA-approved for this indication, lofexidine. Lofexidine’s clinical utility was partially based on its improved safety profile in comparison to clonidine, which had been used off-label for this indication for years. In the current study, BXCL501 reduced the symptoms of opioid withdrawal at doses that produced fewer cardiovascular adverse effects that are major concerns for lofexidine treatment (e.g., orthostatic hypotension, bradycardia, dizziness, somnolence). Unique treatment effects included reductions in insomnia, anxiety, and irritability, which often necessitate the co-prescribing of sleep medication and anxiolytics with lofexidine. Furthermore, the more rapid pharmacokinetics of the sublingual route of administration may offer an advantage of BXCL501 over oral treatments. In sum, in individuals with physiologic opioid dependence undergoing managed opioid withdrawal, BXCL501 was safe, well-tolerated, and reduced withdrawal symptoms. Thus, BXCL501 may prove to be an effective medication with novel treatment benefits so further testing and clinical development are warranted.
Case Report: Concurrent Clonidine Abuse and Opioid Use Disorder
Published in Journal of Psychoactive Drugs, 2021
Review of the clinical treatment guidelines showed a discrepancy as to when clonidine use is recommended in patients exhibiting opioid withdrawal. Both the Department of Veterans Affairs (VA)/Department of Defense (DoD) and American Society of Addiction Medicine guidelines recommend the use of clonidine for opioid withdrawal as a second-line agent (Department of Veterans Affairs and Department of Defense 2015; Kampman and Jarvis 2015). However, the National Institute for Health and Care Excellence (NICE) guidelines do not recommend clonidine be used secondary to the hypotension risk associated with its use (Kampman and Jarvis 2015). The NICE guidelines prefer lofexidine (Lucemyra™) as an alternative to methadone or buprenorphine/naloxone in opioid withdrawal patients (Pilling, Strang, and Gerada 2007). Lofexidine is an alpha 2 adrenergic agonist which has been utilized commonly in Europe for opioid use disorder (Patel and Kosten 2019). Lofexidine has several advantages as it typically does not require dose titration, targets autonomic symptoms, and has fewer side effects, predominantly orthostatic hypotension and associated fainting than clonidine (Patel and Kosten 2019). Lofexidine is not on our institution drug formulary and was not available to be used in this patient case.
Efficacy of lofexidine for mitigating opioid withdrawal symptoms: results from two randomized, placebo-controlled trials
Published in Journal of Drug Assessment, 2020
Danesh Alam, Carlos Tirado, Mark Pirner, Thomas Clinch
As we deal with the impact of the opioid crisis in this country, lofexidine provides an important addition to pharmacotherapy options and is the only non-narcotic approved for the initial opioid discontinuation period, more commonly considered “detox.”