Lofexidine is an alpha-2 adrenergic agonist which can be used in the management of the symptoms of opiate withdrawal. It is a similar drug to clonidine, the use of which is limited due to the likeihood of postural hypotension: this side-effect is less marked with lofexidine.

Lofexidine blocks the adrenaline/noradrenaline related withdrawal symptoms of opiate withdrawal. It does not affect other opiate withdrawal symptoms such as muscle aches, insomnia and craving.

Side effects

Drowsiness, dry mucous membranes, hypotension (usually postural) and bradycardia.

Assessment

Patient must have normal blood pressure. There are no contraindications. All suspect drug reactions should be reported. During withdrawal, blood pressure should be checked if symptoms of postural hypotension develop.

Dosage

1 tablet (200mcg) twice a day, increasing if necessary in steps of 1-2 tablets daily up to a maximum of 12 tablets (2.4mg) daily.

Compliance is most likely if withdrawal from opiates is not attempted until the maximum dose of lofexidine is achieved, at which stage either gradual or sudden withdrawal of opiates may be attempted. Opiates can be reduced gradually over a maximum of 2 weeks, allowing for a further 7-day period of lofexidine treatment and a maximum lofexidine treatment period of 4 weeks. Alternatively, if opiates are stopped abruptly, treatment with lofexidine is usually required for a further 7-10 days.

To prevent rebound hypertension, lofexidine medication should be reduced gradually over 2-4 days.

Lofexidine can be used to reduce withdrawal symptoms in patients

There is no indication for long term treatment with lofexidine