Lofexidine versus diazepam for the treatment of opioid withdrawal syndrome: A double-blind randomized clinical trial in Singapore

Song, Guo; Manning, Victoria; Yang, Yi; Koh, Puay Kee; Chan, Edwin Sy; Souza, Nurun Nisa de; Assam, Pryseley Nkouibert; Sultana, Rehena; Wijesinghe, Ruki; Pangjaya, Julius; Kandasami, Gomathinayagam; Cheok, Christopher; Lee, Kae Meng; Wong, KokSheik

doi:10.1016/j.jsat.2018.04.012

Cited by 17 publications

(28 citation statements)

References 24 publications

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“…But there was no statistically significant difference in the OOWS score on day three and four of the withdrawal (peak of withdrawal). Therefore, it was concluded that lofexidine is at least as effective as diazepam in the treatment of opiate withdrawal [21].…”

Section: Reviewmentioning

confidence: 99%

“…This is of importance because withdrawal symptoms are supposed to be most severe during this time. It can be concluded that lofexidine is associated with better retention rates as compared to diazepam in the treatment of opiate withdrawal [21].…”

Section: Reviewmentioning

confidence: 99%

“…Lofexidine bradycardia, hypotension, orthostasis, dizziness, somnolence, sedation, dry mouth [27] Clonidine sedation, dry mouth, hypotension, drowsiness, dizziness [18,31] Buprenorphine headache, nausea, constipation, vomiting [31,32] Methadone QT interval prolongation, constipation, nausea, sedation, respiratory depression, pruritus [33] Diazepam drop in blood pressure, sleepiness, slow heart rate [21]…”

Section: Adverse Effects Refmentioning

confidence: 99%

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Clinical Efficacy and Safety Profile of Lofexidine Hydrochloride in Treating Opioid Withdrawal Symptoms: A Review of Literature

Rehman¹,

Maqsood²,

Bajwa³

et al. 2019

Cureus

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Opioid use disorder (OUD) is a rapidly growing challenge worldwide and is characterized by an increase in dependence on opioids up to a point that a person loses control over the drug use. Multiple drugs are approved for its treatment, including methadone, buprenorphine, and diazepam. Although not approved, clonidine is also used for the treatment of OUD. On May 16, 2018, the United States Food and Drug Administration (FDA) approved a new drug lofexidine hydrochloride for the treatment of opioid withdrawal symptoms. Lofexidine is a centrally acting alpha two receptor agonist. It reduces the neurochemical surge by inhibiting the conversion of adenosine triphosphate (ATP) into cyclic adenosine monophosphate (cAMP) which in turn decrease the sympathetic outflow. This results in the improvement of withdrawal symptoms. When compared with methadone and buprenorphine, it is equally effective in controlling withdrawal symptoms. Its efficacy is also similar to clonidine with a better side effects profile. The adverse effects of lofexidine include bradycardia, hypotension, orthostasis, somnolence, sedation, dry mouth, and rebound elevations in blood pressure and prolongation of QT interval. Lofexidine is contraindicated in patients who are on beta-blockers and angiotensin converting enzyme inhibitors (ACE inhibitors). In our review, we have discussed the clinical efficacy and safety profile of lofexidine in treating opioid withdrawal symptoms and its comparison to other available treatment options.

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Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Adverse Effects Refmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Efficacy and Safety Profile of Lofexidine Hydrochloride in Treating Opioid Withdrawal Symptoms: A Review of Literature

Rehman¹,

Maqsood²,

Bajwa³

et al. 2019

Cureus

View full text Add to dashboard Cite

show abstract

“…More lofexidine than diazepam patients completed treatment. The investigators concluded that lofexidine was at least as effective as diazepam in managing opioid withdrawal symptoms and treatment retention [28].…”

Section: Comparative Studiesmentioning

confidence: 99%

The Role of Lofexidine in Management of Opioid Withdrawal

et al. 2018

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Fear of withdrawal symptoms has been cited by survey respondents as the main reason that they continued to use opioids. Lofexidine is an α 2 -adrenergic agonist that decreases the sympathetic outflow that results in the characteristic symptoms of opioid withdrawal. A structural analog of clonidine, lofexidine has a higher affinity and specificity for the α 2a receptors and does not reinforce opioid dependence. Withdrawal symptoms correlate approximately to the half-life of the opioid; patient factors such as age, duration of opioid exposure, physical status, and other considerations may influence the nature and duration of withdrawal symptoms. For patients with opioid use disorder and psychiatric comorbidities, withdrawal may be destabilizing and may exacerbate mental health status. Lofexidine has been shown in clinical trials to be safe and effective in helping to manage the symptoms of withdrawal and has been recommended in guidelines for this purpose. Adverse events associated with lofexidine include QT prolongation, hypotension, orthostasis, and bradycardia. The maximum course of treatment is 14 days, and doses should be titrated, with the recommended maximum dose to coincide with the most severe withdrawal symptoms (about 5–7 days after opioid discontinuation).

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“…However, in Singapore, opioid substitutes are not available, due to Singapore's zero tolerance for drug use policy. Instead, individuals with opioid use disorders undergo detoxification using symptomatic medications, followed by psychological interventions [7].…”

Section: Introductionmentioning

confidence: 99%

Gamified M-Health Attention Bias Modification Intervention for Individuals with Opioid Use Disorder: Protocol for a Pilot Randomised Study

Zhang

Heng

Amron

et al. 2020

IJERPH

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Introduction: Globally, there is an epidemic of opioid use disorders. Locally, in Singapore, there is an increase in the number of individuals abusing opioids. The advances in experimental psychology have highlighted the need to modify unconscious, automatic biases. These automatic, unconscious biases result in individuals having preferential attention to substance-related cues in their natural environment, thus leading to a slip or relapse back into their underlying addictive disorders. Prior studies have demonstrated not only the presence of robust attentional biases amongst individuals with opioid use disorder, even when maintained on methadone; and the effectiveness of bias modification amongst these individuals. There remains limited evaluation of attention bias modification amongst a treatment-seeking cohort of Asian individuals. The objective of this pilot is to ensure that the methods of the planned definitive randomized trial could be conducted. Methods and Analysis: A non-blinded pilot randomized trial will be conducted. A total of 30 participants will be randomized to receive either the conventional application or the newly designed co-designed application. In order to identify these 30 participants, 60 participants will be recruited and screened to determine if they have baseline biases. Participants will be recruited from the inpatient unit at the National Addictions Management Service (NAMS) Singapore. All participants who are enrolled into the trial will complete a baseline assessment task, and a bias modification assessment and modification task daily. They will have to complete a baseline demographic and clinical information questionnaire, as well as a cravings rating scale before and after the intervention daily. Perspectives—that of self-reported experiences—will be sought from the participants following their completion of three intervention tasks. Descriptive statistical analyses will be performed, and chi-square and ANOVA analyses will be performed. Qualitative analyses will be undertaken for the perspectives shared. Ethics and Dissemination: Ethical approval has been obtained from the National Healthcare Group’s Domain Specific Research Board (DSRB) (approval number that of 2019/00934). The findings arising from this study will be disseminated by means of conferences and publications.

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Lofexidine versus diazepam for the treatment of opioid withdrawal syndrome: A double-blind randomized clinical trial in Singapore

Cited by 17 publications

References 24 publications

Clinical Efficacy and Safety Profile of Lofexidine Hydrochloride in Treating Opioid Withdrawal Symptoms: A Review of Literature

Clinical Efficacy and Safety Profile of Lofexidine Hydrochloride in Treating Opioid Withdrawal Symptoms: A Review of Literature

The Role of Lofexidine in Management of Opioid Withdrawal

Gamified M-Health Attention Bias Modification Intervention for Individuals with Opioid Use Disorder: Protocol for a Pilot Randomised Study

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