Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE.
Psychopharmacol Bull. 2020 Jul 23;50(3):76-96.
This is a comprehensive review of the literature regarding the use of Lofexidine for opiate withdrawal symptoms. It covers the background and necessity of withdrawal programs and the management of withdrawal symptoms and then covers the existing evidence of the use of Lofexidine for this purpose.
Opiate abuse leads to significant pain and suffering. However, withdrawal is difficult and often accompanied by withdrawal symptoms and renewed cravings. These symptoms are driven mostly by signaling in the locus coeruleus and the mesolimbic system and a rebound increase in noradrenaline, producing symptoms such as anxiety, gastrointestinal upset, and tension. Lofexidine, an alpha-2 agonist, can be used to manage acute withdrawal symptoms before starting maintenance treatment with either methadone or buprenorphine. Lofexidine, if FDA approved for management of withdrawal symptoms and has been proved to be both effective and safe.
Opiate addiction is increasing and plaguing the western world and specifically the U.S. It takes a large toll on both a personal and societal level and carries a high cost. Withdrawal is difficult, both related to withdrawal symptoms and renewed cravings. Lofexidine has been shown to be effective in reducing the former and could potentially aid in recovery and withdrawal.
目的综述：这是一篇关于可乐定用于阿片类戒断症状的文献综述，涵盖了戒断计划的背景和必要性、戒断症状的管理，然后介绍了可乐定用于该目的的现有证据。
最近的发现：阿片类药物滥用会导致严重的痛苦。然而，戒断是困难的，常常伴有戒断症状和重新出现的渴望。这些症状主要是由蓝斑核和中脑边缘系统的信号以及去甲肾上腺素的反弹增加引起的，产生焦虑、胃肠道不适和紧张等症状。可乐定为一种α-2 激动剂，可在开始使用美沙酮或丁丙诺啡维持治疗之前用于治疗急性戒断症状。如果可乐定获得 FDA 批准用于管理戒断症状，并已被证明是有效和安全的，那么它可能会辅助戒断和恢复。
总结：阿片类药物成瘾正在增加，并困扰着西方世界，特别是美国。它给个人和社会都带来了巨大的代价，而且成本很高。戒断既与戒断症状有关，也与重新出现的渴望有关。可乐定已被证明能有效减轻前者，可能有助于康复和戒断。
