This is a non-opioid alpha-adrenergic agonist. It is licensed to relieve symptoms in patients undergoing opioid detoxification. It has a role in patients seeking abstinence, whose drug use is well controlled. Lofexidine is effective in the reduction of withdrawal symptoms during opioid detoxification. (1,2)
Lofexidine
- has a similar action to clonidine, but causes less hypotension
- is likely to be useful in patients who have an average daily heroin usage of up to 1g per day, (or 50mg methadone equivalent), and short treatment and drug histories
- treatment course is between 7-10 days with doses starting at 800 micrograms daily and rising to a maximum of 2.4 mg in divided doses
- dose is then reduced over subsequent days
- most likely to be successful for patients with uncertain dependence, young people and shorter drug and treatment histories
Notes
- methadone or buprenorphine should be offered as the first-line treatment in opioid detoxification. When deciding between these medications, healthcare professionals should take into account:
- whether the service user is receiving maintenance treatment with methadone or buprenorphine; if so, opioid detoxification should normally be started with the same medication
- the preference of the service user
- lofexidine may be considered for people:
- who have made an informed and clinically appropriate decision not to use methadone or buprenorphine for detoxification
- who have made an informed and clinically appropriate decision to detoxify within a short time period
- with mild or uncertain dependence (including young people)
- clonidine should not be used routinely in opioid detoxification
- dihydrocodeine should not be used routinely in opioid detoxification
Reference:
- NICE. Drug misuse in over 16s: opioid detoxification. Clinical guideline CG52. Published July 2007, last reviewed December 2024
- Urits I et al. A Comprehensive Update of Lofexidine for the Management of Opioid Withdrawal Symptoms. Psychopharmacol Bull. 2020 Jul 23;50(3):76-96