MIAMI — Lofexidine (Lucemyra, US Worldmeds), which has been in use in the United Kingdom for more than 20 years, is now available in the United States. The drug is used in the management of symptoms of severe opioid withdrawal. In a double-blind, placebo-controlled, multicenter trial in opioid-dependent patients, lofexidine significantly improved opioid withdrawal symptoms and significantly increased completion of a 7-day opioid discontinuation treatment program compared with placebo. "We desperately need something to address the opioid crisis, where we are losing about 100 Americans every day, with some 16 million on opioids," Danesh Alam, MD, Northwestern Medicine Central Dupage Hospital, Winfield, Illinois, told Medscape Medical News. "Now we have a drug that actually enables us to achieve a rapid withdrawal from opioids. When we use lofexidine, we can literally bring in someone using opioids, give them this drug, and they can immediately stop using opioids," said Alam. The study was presented at the American Society for Clinical Psychopharmacology (ASCP) 2018. A Better Alternative Currently, the standard of care for the treatment of opioid withdrawl is medication-assisted therapy with buprenorphine (multiple brands), but many patients wish to stop using opioids completely, Alam said. "Buprenorphine is essentially another opioid, albeit a designer opioid, but a number of patients object to clinicians saying that the best evidence is to switch them over to buprenorphine and do buprenorphine for the rest of their life," he said. Lofexidine, a selective alpha-2-adrenergic agonist, acts on the central nervous system. Through its effect on the brain stem, it reduces the symptoms of withdrawal to a point at which they become very tolerable. "We found in our study that you could basically give patients the lofexidine and stop the opiate. In the majority of cases, the withdrawal symptoms at that point were mild," Alam said. The researchers enrolled 602 men and women aged 18 years or older who sought treatment for dependence on short-acting opioids. Most were men (71%); the mean age of the patients was 35 years (±11 years). Most patients (83%) were dependent on heroin. Participants were randomly assigned to receive placebo, lofexidine 0.6 mg qid (2.4 mg/day), or lofexidine 0.8 mg qid (3.2 mg/day) for 7 days after abrupt opioid discontinuation. The study assessed the benefit of lofexidine with the Short Opiate Withdrawal Scale–Gossop (SOWS-G), a 10-item inventory of common opioid withdrawal symptoms in which higher scores indicate worse symptoms; by the percentage of participants who completed the study; and by use of the Clinical Opiate Withdrawal Scale (COWS), an 11-item inventory of opioid withdrawal signs and symptoms in which higher scores indicate worse symptoms. Source
