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A Comprehensive Update of Lofexidine for the Management of Opioid Withdrawal Symptoms
Ivan Urits1, Anjana Patel1, Robbie Zusman1
1Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE.
Purpose Of Review:
This is a comprehensive review of the literature regarding the use of Lofexidine for opiate withdrawal symptoms. It covers the background and necessity of withdrawal programs and the management of withdrawal symptoms and then covers the existing evidence of the use of Lofexidine for this purpose.
Recent Findings:
Opiate abuse leads to significant pain and suffering. However, withdrawal is difficult and often accompanied by withdrawal symptoms and renewed cravings. These symptoms are driven mostly by signaling in the locus coeruleus and the mesolimbic system and a rebound increase in noradrenaline, producing symptoms such as anxiety, gastrointestinal upset, and tension. Lofexidine, an alpha-2 agonist, can be used to manage acute withdrawal symptoms before starting maintenance treatment with either methadone or buprenorphine. Lofexidine, if FDA approved for management of withdrawal symptoms and has been proved to be both effective and safe.
Summary:
Opiate addiction is increasing and plaguing the western world and specifically the U.S. It takes a large toll on both a personal and societal level and carries a high cost. Withdrawal is difficult, both related to withdrawal symptoms and renewed cravings. Lofexidine has been shown to be effective in reducing the former and could potentially aid in recovery and withdrawal.
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