Lofexidine

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 (1). Lofexidine is effective in the reduction of withdrawal symptoms during opioid detoxification.

Lofexidine

• has a similar action to clonidine, but causes less hypotension (2)
• 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 (2)
• 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 (3)
  • 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 (4)

• 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:

• (1) MeRec Bulletin (2002), 12 (4), 13-16.
• (2) Department of Health, Scottish Department of Health, Welsh Office, Department of Health and Social Services Northern Ireland. Drug misuse and dependence - guidelines on clinical management. London: The Stationery Office, 1999. URL: http://www.doh.gov.uk/drugdep.htm
• (3) RCGP (2007). Drug misuse and dependence: UK guidelines on clinical management
• (4) NICE (July 2007).Drug misuse - Opioid detoxification