Use of lofexidine in the management of opiate dependence syndrome

A systematic review was undertaken in order to evaluate the potential usefulness of lofexidine as a treatment option in the management of opiate dependency. All available data were retrieved by means of a comprehensive search of the published literature. Contact was made with experts in Ireland to evaluate the practical issues associated with use of lofexidine in a clinical setting. Evaluation of clinical trials data for lofexidine showed that it appeared to be at least as effective as clonidine and reducing doses of methadone, the other treatment regimens currently used in the treatment of opiate withdrawal. It was not possible to define the optimal dosage regimen for this indication, because of the lack of data from controlled trials, but in general incremental dosing was used reaching a maximum of around 2.2mg/day by day 3-4, with gradual tapering of dose until zero by day 10. Evaluation of its use in clinical practice showed that it was considered as effective as clonidine for managed withdrawal but had a better safety profile (i.e. less hypotension). Experts have suggested that lofexidine detoxification requires (intensive input from all members of the drug treatment team and should be followed up by further treatment to prevent relapse. Although there were insufficient data to evaluate its use in specific subgroups, most workers have suggested that lofexidine is more effective in younger patients and those who have a shorter, less entrenched history of opiate use. The review suggests that lofexidine may be useful as an additional treatment for managed opiate withdrawal. (Extract of the publication)