lofexidine

Last reviewed 01/2018

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: