Lofexidine lowers need for supportive medications to control opioid withdrawal symptoms

Mark Pirner

Results from a study presented at Psych Congress suggested that lofexidine can effectively mitigate symptoms of opioid withdrawal syndrome during peak withdrawal — a “critical period” for treating opioid withdrawal symptoms and transitioning to treatment for opioid use disorder.

“As expected, fewer supportive medications such as acetaminophen and bismuth were needed with lofexidine treatment compared with placebo to treat and manage opioid withdrawal syndrome using a nonopioid withdrawal management plan,” researcher Mark Pirner, MD, PhD, told Healio Psychiatry. “Reduced adjunctive medication needs correlated with better retention during withdrawal treatment. These results highlight that patient comfort is a key variable to successfully managing opioid withdrawal.”

Pirner and Thomas Clinch, BS, of U.S. WorldMeds LLC, noted that patients with opioid use disorder (OUD) often continue opioids to avoid withdrawal symptoms, which are caused by abrupt discontinuation of opioids after chronic use and the resulting noradrenergic hyperactivity. The nonopioid treatment lofexidine is an alpha-adrenergic receptor agonist approved for mitigation of OWS, they wrote.

The researchers conducted a randomized, 7-day inpatient trial to compare the use of supportive symptomatic medications for opioid withdrawal symptoms in patients treated with lofexidine vs. placebo. They assigned 229 patients to 2.16 mg of lofexidine four times daily, 222 patients to 2.88 mg once daily and 151 patients to placebo. All patients were aged 18 years or older and abruptly withdrew from short-acting opioids. The majority were white, male and previously used heroin. Permitted supportive medications included acetaminophen, antacids, bismuth and zolpidem.

Pirner and Clinch found that more patients in the placebo group used supportive medications vs. patients in both lofexidine groups between days 2 and 5, suggesting lofexidine offers “better symptom control,” they wrote in the poster.

According to the researchers, the differences were greatest with acetaminophen and bismuth. The most common adverse reactions for the lofexidine groups were orthostatic hypotension, bradycardia, hypotension, dizziness, somnolence, sedation and dry mouth.

“It is good to see the consistency of lofexidine treatment efficacy, and these findings highlight the opportunity to reduce medication burden of patients who require opioid-free withdrawal management,” Pirner said. – by Joe Gramigna

Reference:

Pirner, M. Clinch, T. Use of supportive medication for opioid withdrawal syndrome in a randomized, placebo-controlled trial of lofexidine. Presented at: Psych Congress; Oct. 3-6, 2019; San Diego.

Disclosures: Clinch and Pirner are employees of U.S. WorldMeds LLC.