Washton A M, Resnick R B
Pharmacotherapy. 1981 Sep-Oct;1(2):140-6. doi: 10.1002/j.1875-9114.1981.tb03561.x.
Studies in animals and humans have demonstrated that clonidine hydrochloride, an alpha-2-noradrenergic agonist, significantly attenuates the opiate withdrawal syndrome. Inpatient and outpatient clinical studies have shown that clonidine is a reasonably safe, specific, and effective agent for detoxifying opiate addicts. Clonidine seems best suited for use as a transitional treatment between opiate dependence and induction onto the opiate antagonist naltrexone. Dosage regimens of clonidine must be individualized according to symptoms and side effects and closely supervised because of varying sensitivity to clonidine's sedative, hypotensive, and withdrawal-suppressing effects. Clonidine is an important new treatment option for selected opiate addicts and may be the treatment of choice when detoxification using methadone is inappropriate, unsuccessful, or unavailable. Lofexidine, a structural analogue of clonidine, may be safer and more effective as an opiate detoxification treatment. It has similar withdrawal-suppressing actions but causes little hypotension and sedation. Although clonidine and lofexidine may be highly effective in helping opiate addicts achieve initial abstinence, a multi-modality aftercare treatment approach including naltrexone and psychotherapy may be necessary to maintain an abstinent state.
对动物和人类的研究表明，α-2去甲肾上腺素能激动剂盐酸可乐定可显著减轻阿片戒断综合征。住院和门诊临床研究表明，可乐定是用于阿片成瘾者脱毒的一种相当安全、特效且有效的药物。可乐定似乎最适合用作从阿片依赖过渡到使用阿片拮抗剂纳曲酮诱导治疗的中间治疗方法。由于对可乐定的镇静、降压及戒断抑制作用的敏感性不同，可乐定的给药方案必须根据症状和副作用进行个体化调整，并需密切监测。对于某些阿片成瘾者，可乐定是一种重要的新治疗选择，当使用美沙酮进行脱毒不合适、不成功或无法进行时，可乐定可能是首选治疗方法。洛非西定是可乐定的结构类似物，作为阿片脱毒治疗可能更安全、更有效。它具有类似的戒断抑制作用，但几乎不会引起低血压和镇静作用。尽管可乐定和洛非西定在帮助阿片成瘾者实现初步戒断方面可能非常有效，但可能需要包括纳曲酮和心理治疗在内的多模式后续治疗方法来维持戒断状态。
