Low dose lofexidine for medically directed outpatient opioid tapering in adults with chronic pain: a prospective case series

• Published in: Journal of medical case reports 2024-01, Vol.18 (1), p.20-20, Article 20
• Main Authors: Ellis, Megan M, Eberhart, Nathan D, Warner, Nafisseh S, Hooten, W Michael
• Format: Article
• Language: English
• Subjects: Abstinence; Blood pressure; Cardiac arrhythmia; Chronic illnesses; Chronic pain; Clinical outcomes; Clinical significance; Clinical trials; Demographics; Drug dosages; Drug testing; Drug withdrawal; FDA approval; Fibromyalgia; Heart rate; Hispanic Americans; Hypertension; Hypotension; Interdisciplinary aspects; Lofexidine; Marijuana; Morphine; Narcotics; Opioid withdrawal; Pain management; Patients; Questionnaires; Rehabilitation; Tachycardia; Validity
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-023-04309-x

In adults with chronic pain, mild-to-moderate withdrawal symptoms during medically directed opioid tapering in the outpatient setting may not be accompanied by hypertension or tachycardia. This clinical scenario could limit the use of lofexidine at dosages reported in clinical trials of opioid withdrawal precipitated by abrupt opioid discontinuation. Thus, the primary aim of this prospective case series is to describe the use of low dose lofexidine for opioid withdrawal in patients with chronic pain undergoing medically directed opioid tapering in an outpatient setting. Six patients (white 5, Latino 1) admitted to an outpatient interdisciplinary pain rehabilitation program met inclusion and exclusion criteria. Patients self-selected to undergo medically directed opioid tapering, and the medication the patients were prescribed upon admission was used in the taper schedule. Upon initiation of the opioid taper, patients received 0.18 mg of lofexidine every 6 hours. Five of the six patients were women, and the median morphine milligram equivalents at baseline were 36.9. The median taper duration was 15 days, and the median duration of lofexidine administration was 14 days. Withdrawal scores were mild throughout the taper in four patients, and two patients with fibromyalgia experienced single episodes of moderately severe withdrawal symptoms at the median morphine milligram equivalent midpoint of the taper. No hypotension or sustained bradycardia were observed, and no adverse effects related to lofexidine were reported. The observations from this prospective case series suggest that low-dose lofexidine may be a feasible adjunct medication to attenuate withdrawal symptoms in adults with chronic pain undergoing outpatient opioid tapering.