Audit of the in-patient management of opioid withdrawal using lofexidine hydrochloride

Over a period of 24 months, data were collected on 214 opioid detoxifications (190 patients), based on lofexidine hydrochloride. A mean maximum daily dose of 2.1 mg lofexidine was achieved by day 4 of admission. This was associated with a small fall in systolic and diastolic blood pressure, and 16% patients required adjustment to the daily dose of lofexidine or the withholding of doses. Seventy-five percent of patients were given adjunctive prescription of diazepam, and approximately a half required analgesics. By week I (day 8), 81 (37.9%) patients remained in treatment. Lofexidine appears to be a useful treatment for opioid detoxification, subject to certain limitations, and, despite a more marked reduction in both systolic and diastolic pressure than has previously been reported, hypotension does not appear to limit its usefulness—at least in an in-patient setting. Induction of lofexidine may proceed more rapidly, and to a higher dosage, than currently recommended, without any apparent widespread problems.