Which medications in the drug class Alpha 2 adrenergic agonists are used in the treatment of Opioid Abuse?

Updated: Jun 21, 2018
  • Author: David W Dixon, DO; Chief Editor: Glen L Xiong, MD  more...
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Answer

Alpha 2 adrenergic agonists

Used for mitigation of withdrawal symptoms to facilitate abrupt opioid discontinuation.

Lofexidine (Lucemyra)

Central alpha-2 adrenergic agonist that binds to receptors on adrenergic neurons, resulting in reduced release of norepinephrine and decreased sympathetic tone. This action suppresses autonomic-mediated signs and symptoms of withdrawal. Indicated for short-term mitigation of withdrawal symptoms to facilitate abrupt opioid discontinuation in adults.

Clonidine (Catapres)

May reduce norepinephrine release. In opioid withdrawal, seems to be most effective in suppressing autonomically mediated signs and symptoms of abstinence but less effective for subjective symptoms.

Used in higher doses for detoxification than for treating hypertension. Benzodiazepines may be beneficial as adjuvant therapy for muscle cramps and insomnia. Clonidine in combination with naltrexone, which is a potent long-acting narcotic antagonist, also is referred to as rapid detoxification. Treatment is initiated after confirmation of physical dependence by the naloxone challenge test. This drug combination is designed to shorten the time of withdrawal to 5 d.

Clonidine may also be beneficial in prolonging the duration of abstinence in patients concurrently receiving buprenorphine for maintenance therapy. Daily life stress may also be partially decoupled from opioid craving in patients receiving clonidine. However, although clonidine may prolong the time to relapse, it may not prevent it entirely. Clonidine alone and in combination has been demonstrated to be feasible in primary care settings as an outpatient treatment.

 


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