Alcohol withdrawal syndrome: clinical and hormonal responses to alpha 2-adrenergic agonist treatment

Lofexidine (L) was compared to placebo (P) in a random double blind placebo controlled study of 23 healthy alcoholics in withdrawal. In serial alcohol withdrawal syndrome (AWS) scales, P greater than L for first 18 hr. The major changes in AWS were in blood pressure and pulse, while restlessness or diaphoresis did not show faster normalization with L vs. P. Other ratings of withdrawal intensities and craving by patients were similar in both P and L. There were no differences in the rate of patient completion, or appearance of hallucinations by group. Plasma catecholamines were in the high ranges, similar in both groups at 0 and 3 hr, but after 5 hr P greater than L for norepinephrine (but not epinephrine or dopamine). The data suggest L has pharmacological effects on some objective, catecholamine related, components of alcohol withdrawal, with little effect on others. L type treatment of alcoholics in withdrawal is promising, modestly effective and warrants further study.