The clinical utility of lofexidine and diazepam in reducing the craving in patients undergoing opioid detoxification

First published: 10 May 2019 | Last updated: 20 May 2019

Withdrawal symptoms are common encounters in addiction clinics where appropriate management is warranted. Opioid substitution is an effective therapeutic strategy in the suppression of acute symptoms, however, is controlled in Singapore, where the management is solely done with diazepam which has addictive properties. Preclinical studies indicate that lofexidine reduces stress induced opioid craving in animals. We have compared the clinical efficiency of lofexidine and diazepam in the management of craving during inpatient opioid detoxification. This study is a phase lV, single site, randomised, double-blind, parallel group, double dummy investigator initiated trial. The study subjects (n=111) were treatment seeking clinical population who were assigned to either diazepam (2 mg) or lofexidine (0.2 mg) arm for a period of 14 days. The craving was measured using the visual analogue scale and analysed using two sample t-test. No baseline differences in craving were recorded between the groups.  The mean scores for craving were lower in the lofexidine group throughout the study period when compared to diazepam; nonetheless, the values were not statistically significant. On day 3, a mean score of 3.7 (±3.26) and 4.2 (±3.54) was observed for lofexidine and diazepam, respectively. The scores dropped steadily over time, recording 2.6 (±2.85 for lofexidine) versus 3.2 (±3.08, diazepam) on day 4 and 1.4 (±2.41, lofexidine) compared to 1.9 (±3.01, diazepam) on day 14. Although not statistically significant, a downward trend in craving was observed in both groups, with lofexidine showing consistently lower scores.


Yang Yi (Ms): National Addictions Management Services, Institute of Mental Health, Singapore Wong Kim Eng (Prof):National Addictions Management Services, Institute of Mental Health, Singapore Guo Song (Dr):National Addictions Management Services, Institute of Mental Health, Singapore

Conflicts of interest:

Funding Sources: Woodbridge Hospital Charity Fund

No conflict of interest


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Dr AshaRani PV