A while ago I wrote a blog about Lofexidine ( Lucemyra). I basically said that there’s not a ton of data but what seemed clear is that it’s crazy ridiculous expensive and really not any better than Clonidine. At a 1000X higher price. Well, I proved to be right.

Dr. David Juurlink MD Ph.D. from Sunnybrook Health Sciences in Toronto, Canda wrote a terrific summary of the most complete, robust up to date study on lofexidine. Just published in the May/June 2019 edition of the Journal of Addiction Medicine. ” Safety and Efficacy of Lofexidine for Medically Managed Opioid Withdrawal: A Randomized Controlled Clinical Trial” Fishman MD, Tirado MD, Alam MD.etc. al.

This was a multicenter Double-blind placebo-controlled study of 603 patients at 18 different US Centers. Keep in mind two of the authors are paid consultants to the manufacturer of Lofexidine. What did we learn?

  1. Lofexidine does slightly reduce withdrawal compared to placebo.
  2. As mentioned in my previous blog,  Lofexidine and Clonidine are pharmacologically and structurally similar
  3. A review of all randomized trials comparing lofexidine with clonidine in patients suffering opioid withdrawal have shown the reduction of withdrawal symptoms are the same.
  4. The benefit of lofexidine on withdrawal is maximal by day 2. No difference from placebo is evident by day 7.
  5. Clonidine has slightly more side effects such as light-headed, dizzy and drowsy.
  6. 7 days of Lofexidine in the US is about $1700 compared to $1 for Clonidine

” In short, lofexidine can be viewed as a slightly safer version of clonidine that offers patients with opioid withdrawal marginal clinical benefit for perhaps a few days, at a cost of more than $3000o over a typical 2 week treatment period.”.

 

Drug company price gouging for a “me too” drug for the most desperate and vulnerable of patients.

 

Ken Starr MD

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