Lofexidine 0.18 mg (Generic LUCEMYRA)

By Dr. Rachita Narsaria

What Is This Drug?

LUCEMYRA is an oral tablet for reducing the severity of opioid withdrawal symptoms in adults. It aids in abrupt discontinuation of opioids. It has lofexidine as its active ingredient. [1] Lofexidine acts as a potent agonist of the alpha-2-adrenergic receptor, which helps in minimizing the severity of the withdrawal symptoms. [2]

Classification and Mechanism of Action

Lofexidine is a centrally acting alpha-2-antiadrenergic receptor agonist. [2] It is used in mitigating opioid withdrawal symptoms in adults who want to discontinue opioids. [1] When an individual is using an opioid, it inhibits cyclic adenosine monophosphate (cAMP). Abrupt discontinuation of opioids may cause an increase in cAMP levels, which in turn increase norepinephrine levels leading to withdrawal symptoms. [2]

Lofexidine activates the alpha-2-adrenergic receptor, which in turn inhibits the synthesis of norepinephrine. Thus, lofexidine aids in minimizing the severity of the withdrawal symptoms. [2]

Looking After Your Drug

Store in a cool place. Protect from moisture, direct sunlight, and heat. Do not freeze. Keep it away from children. Store it at 25°C; variations permitted from 15°C to 30°C. The desiccant packs should not be removed from the bottles unless all the tablets are used. [1]

Dosage Form and Strength

Lofexidine is available in tablet form in one strength only, which contains 0.18 mg of lofexidine, equivalent to 0.2 mg of lofexidine hydrochloride. [1]

Dosage

Three tablets of lofexidine 0.18 mg should be taken by mouth four times a day with a gap of five to six hours between each dose, with or without food. [1, 3] The therapy may be continued for about 14 days. A gradual decrease in the dose for a period of two to four days is needed before discontinuation. Take lofexidine tablet as directed by the physician. Do not take lesser or higher number of doses of lofexidine than prescribed by your doctor. [1]

How to Take the Medication?

Lofexidine should be consumed only on the prescription of a doctor. Lofexidine should be taken with water, before or after meals. It is not recommended in individuals below 18 years of age. [1]

Overdose

Lofexidine overdose may cause reduced blood pressure, reduced heart rate, and sedation. Seek medical help from the nearest hospital in case of overdose. Removing unabsorbed material from the gastrointestinal tract through gastric lavage, supportive therapy, and clinical monitoring is the primary treatment employed for an overdose of lofexidine. The exact treatment is based on the symptoms. Dialysis is not useful in removing a sufficient amount of the drug from the body. [3]

Warnings and Precautions

Lofexidine should be avoided in pregnant women as its safety in pregnant women is not established. It should be given with caution to breastfeeding mothers. Special precautions and dose adjustments are needed in individuals above 65 years of age. Dose adjustments are also required in individuals with impaired liver or impaired renal function. The dosage will vary depending upon the degree of impairment. Individuals with congestive heart failure must be evaluated for their electrocardiogram reports. In patients with electrolyte imbalance, the imbalance should be corrected before the beginning of the therapy. Lofexidine must be avoided in individuals below 18 years of age as no data is available on the drug effects on the population of that age group. It interacts with certain medications like antidepressants and prolongs its action. Therefore, do not use any other medicines in combination with lofexidine without consulting your doctor. [1]

Individuals who discontinue the use of opioids completely may have a reduced tolerance to opioids and suffer from fatal overdose effects if they resume it. Lofexidine is not useful in treating opioid use disorder and should be used in combination with other therapies. [1]

Possible Side Effects

Lofexidine is an oral treatment for opioid withdrawal symptoms in adults. Before using this drug, individuals should consult a doctor. Some of the side effects are: [1]

• Lofexidine causes a lowering of blood pressure and heart rate, which can be resolved by reducing, delaying, or skipping the dose.
• Sudden discontinuation of lofexidine therapy may cause symptoms like high blood pressure, diarrhea, insomnia, anxiety, chills, and pain in extremities. These discontinuation symptoms can be avoided by gradually reducing the dose after consulting your doctor.

Consult a physician if any of the side effects of lofexidine are observed.

When the Drug Should Not Be Used?

Before the treatment, the medical history of the patient should be studied in detail. The doctor must be informed about any kidney or liver conditions, alcoholism, low blood pressure, slow heart rate, history of heart attack, prolonged QT syndrome, current or future pregnancy plans, and breastfeeding. The doctor should be given information regarding any prescription, over-the-counter, herbal or nutritional medicines taken by the patient, especially if it is an antidepressant or antianxiety drug therapy. [1]

References

1. Highlights of prescribing information [Internet] [Updated 2018]. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/209229s000lbl.pdf. Accessed on Oct 16, 2018.
2. Lofexidine [Internet] [Updated Oct 10, 2018]. Available at: https://www.drugbank.ca/drugs/DB04948. Accessed on Oct 16, 2018.
3. Drug label information [Internet] [Updated July 18, 2018]. Available at: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bdcfe803-b556-47db-a54f-ae0f0e5be016. Accessed on Oct 16, 2018.