Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-10T13:34:33.276Z Has data issue: false hasContentIssue false
  • English
  • Français

Lofexidine for opiate detoxification

Published online by Cambridge University Press:  24 June 2014

Jenny Bearn
Jenny Bearn*
Affiliation:
South London & Maudsley NHS Trust, National Addiction Center, Institute of Psychiatry, Windsor Walk, London, UK
*
Jenny Bearn, Wickham Park House, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK. Tel: (44) 0208 776 4114; Fax: (44) 0208 776 2026; E-mail: jenny.bearn@slam-tr.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

The evolving role for lofexidine in the treatment of opiate detoxification over the last decade is reviewed. Lofexidine is no better than methadone or clonidine in attenuating withdrawal symptom severity, although it has a more favourable side-effect profile than clonidine. In conjunction with opiate antagonists, lofexidine may facilitate accelerated withdrawal, although activity and low liability for misuse, lofexidine may be more widely acceptable to clinicians than methadone, particularly those working in out-patient, non-specialist and prison treatment settings. Further studies in these treatment settings will be particularly apposite since, apart from the studies highlighted, the evidence base for the clinical value of lofexidine is mainly to be derived from in-patient trials.

Keywords

opiatedetoxificationlofexidineherointreatment
Type
Original Article
Information
Acta Neuropsychiatrica , Volume 16 , Issue 5 , October 2004 , pp. 239 - 245
Copyright
Copyright © 2004 Blackwell Munksgaard

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Gold, MS, Pottash, AC, Sweeney, DR, Exstein, I, Annitto, WJ. Opiate detoxification with lofexidine. Drug Alcohol Depend 1981;50: 251–254. Google Scholar
Washton, AM, Resnick, RB. Lofexidine in abrupt methadone withdrawal. Psychopharmacol Bull 1982;18: 220–221.Google ScholarPubMed
Washton, AM, Resnick, RB, Geyer, G. Opiate withdrawal using lofexidine – a clonidine analogue with fewer side effects. J Clin Psychiatry 1983;44: 335–337.Google ScholarPubMed
Gowing, L, Farrell, M, Ali, R, White, J. Alpha-2-adrenergic agonists for the management of opioid withdrawal (Cochrane Review). In: The Cochrane Library. Chichester, UK: John Wiley & Sons, Limited, 2003. Google Scholar
Strang, J, Bearn, J, Gossop, M. Lofexidine for opiate detoxification: review of recent randomised and open control trials. Am J Addict 1999;8: 337–348.DOI: 10.1080/105504999305749Google Scholar
Rasmussen, K, Beitner-Johnson, D, Krystal, JH, Aghajanian, GK, Nestler, EJ. Opiate withdrawal and the rat locus coeruleus: behavioural, electrophysiological and biochemical correlates. J Neurosci 1990;10: 2308–2317.Google ScholarPubMed
Nestler, EJ, Meenakshi, A, Aghajanian, GK. Molecular control of locus coeruleus neurotransmission. Biol Psychiatry 1999;46: 1131–1139.DOI: 10.1016/S0006-3223(99)00158-4CrossRefGoogle ScholarPubMed
Taylor, JR, Elsworth, JD, Garcia, ES, Grant, J, Roth, RM, Redmond, DE Jr. Clonidine infusions into the locus coeruleus attenuate behavioural and neurochemical changes associated with naloxone-precipitated withdrawal. Psychopharmacology 1990;96: 121–134. CrossRefGoogle ScholarPubMed
Gossop, M. Clonidine and the treatment of the opiate withdrawal syndrome. Drug Alcohol Depend 1988;21: 253–259 .DOI: 10.1016/0376-8716(88)90078-6CrossRefGoogle ScholarPubMed
Bearn, J, Gossop, M, Strang, J. Randomised double-blind comparison of lofexidine and methadone in the in-patient treatment of opiate withdrawal. Drug Alcohol Depend 1996;43: 87–91.CrossRefGoogle ScholarPubMed
Kahn, A, Mumford, JP, Rogers, GA, Beckford, H. Double-blind study of lofexidine and clonidine in the detoxification of opiate addicts in hospital. Drug Alcohol Depend 1997;44: 57–61.DOI: 10.1016/S0376-8716(96)01316-6CrossRefGoogle ScholarPubMed
Lin, S-K, Strang, J, Su, LW, Tsai, CJ, Hu, WH. Double blind randomised controlled trial of lofexidine versus clonidine in the treatment of heroin withdrawal. Drug Alcohol Depend 1997;48: 127–133 .DOI: 10.1016/S0376-8716(97)00116-6CrossRefGoogle ScholarPubMed
Carnwath, T, Hardman, J. Randomised double-blind comparison of lofexidine and clonidine in the out-patient treatment of opiate withdrawal. Drug Alcohol Depend 1998;50: 251–254.CrossRefGoogle ScholarPubMed
Bearn, J, Gossop, M, Strang, J. Accelerated lofexidine treatment regimen compared with conventional lofexidine and methadone treatment for in-patient opiate detoxification. Drug Alcohol Depend 1998;50: 227–232.CrossRefGoogle ScholarPubMed
Burroughs, W. Letter from a master addict to dangerous drugs. Br J Addict 1956;53: 119–131. CrossRefGoogle Scholar
Bearn, J, Gossop, M, Strang, J. Rapid opiate detoxification treatments: a review. Drug Alcohol Rev 1999; 18: 75–81. CrossRefGoogle Scholar
Pfab, R, Hirtl, C, Zilker, T. Opiate detoxification under anaesthesia: no apparent benefit but suppression of thyroid hormones and risk of pulmonary and renal failure. J Toxicol Clin Toxicol 1999;37: 43–50.DOI: 10.1081/CLT-100102407CrossRefGoogle ScholarPubMed
Buntwal, N, Bearn, J, Gossop, M, Strang, J. Naltrexone and lofexidine combination treatment compared with conventional lofexidine treatment for in-patient opiate detoxification. Drug Alcohol Depend 2000;59: 183–188.CrossRefGoogle ScholarPubMed
Merrill, J, Marshall, R. Opioid detoxification using naloxone. Drug Alcohol Rev 1997;16: 3–6. CrossRefGoogle ScholarPubMed
Bearn, J, Bennett, J, Martin, T, Gossop, M, Strang, J. The impact of naloxone/lofexidine combination treatment on the opiate withdrawal syndrome. Addict Biol 2001;6: 147–156.DOI: 10.1080/13556210020040226CrossRefGoogle ScholarPubMed
Beswick, T, Best, D, Bearn, J, Gossop, M, Rees, S, Strang, J. The effectiveness of combined naloxone/lofexidine in opiate detoxification: results from a double-blind randomised and placebo-controlled trial. Am J Addict 2003;12: 1–11.CrossRefGoogle Scholar
Gunn, J, Maden, T, Swinton, M. Mentally disordered prisoners. A report commissioned and published by the Home Office, 1991. Google Scholar
Cairns, A, Roberts, I, Benbow, EW. Characteristics of fatal methadone overdose in Manchester 1985–94. BMJ 1996;313: 264–265.CrossRefGoogle ScholarPubMed
Howells, C, Allen, S, Gupta, J, Stillwell, G, Marsden, J, Farrell, M. Prison based detoxification for opioid dependence: a randomised double-blind controlled trial of lofexidine and methadone. Drug Alcohol Depend 2002;67: 169–176.DOI: 10.1016/S0376-8716(02)00024-8CrossRefGoogle ScholarPubMed
Kleber, H. Detoxification from narcotics. In: Lowinson, J, Ruiz, P, eds. Substance abuse. Baltimore: Williams & Wilkins, 1981. Google Scholar
Oyefeso, A, Sedgewick, P, Ghodse, H. Subjective sleep-wake parameters in treatment – seeking opiate addicts. Drug Alcohol Depend 1997;48: 9–16.DOI: 10.1016/S0376-8716(97)00097-5CrossRefGoogle ScholarPubMed
Beswick, T, Best, D, Rees, S, Bearn, J, Gossop, M, Strang, J. Major disruptions of sleep during treatment of the opiate withdrawal syndrome: differences between methadone and lofexidine detoxification treatments. Addict Biol 2003;8: 49–57.CrossRefGoogle ScholarPubMed
Ghodse, H, Myles, J, Smith, SE. Clonidine is not a useful adjunct to methadone gradual detoxification in opioid addiction. Br J Psychiatry 1994;165: 370–374.CrossRefGoogle Scholar
Product information, Britannia Pharmaceuticals, 2003. Google Scholar
Keaney, F, Crimlisk, H, Bearn, J. Lofexidine and desipramine: interaction results in breakthrough opioid withdrawal symptoms. Int J Psychiatr Clin Pract 2002;6: 179–181 .DOI: 10.1080/136515002760276135CrossRefGoogle ScholarPubMed
Sheridan, J, Cook, C, Strang, J. Audit of the in-patient management of opioid withdrawal using lofexidine hydrochloride. J Substance Misuse 1999;4: 92–97 . CrossRefGoogle Scholar
White, R, Alcorn, R, Feinmann, C. Two methods of community detoxification from opiates: an open label comparison of lofexidine and buprenorphine. Drug Alcohol Depend 2001;65: 77–83.DOI: 10.1016/S0376-8716(01)00149-1CrossRefGoogle ScholarPubMed