A Commentary: Do α2-Adrenergic Agonists Decrease the Symptoms Associated With Opioid Withdrawal?

Abstract

We thank you for your insightful comments with respect to the appropriate treatment and management of opioid withdrawal in the emergency department (ED) setting. We agree with Drs. Flemming and Hoffman in regard to the importance of appropriate referral and follow-up after presentation for acute opioid withdrawal.

Efficacy of Lofexidine in the Outpatient Management of Tramadol Withdrawal Syndrome

“…Tramadol is a highly toxic opioid, causing severe side effects, such as withdrawal syndrome, respiratory distress, rhabdomyolysis, acute renal failure, seizures, and death [5]. In recent years, tramadol withdrawal syndrome and its treatment have become an important issue in the healthcare system [6]. Symptoms of tramadol-induced withdrawal syndrome are restless legs syndrome, insomnia, irritability, diarrhea, insomnia, abdominal spasm, headaches of migraine type, dysfunction of the autonomic system, and myoclonus in extremities [7,8].…”

“…Also, psychosis with its signs and symptoms, such as paranoia, illusions, and delusions are the atypical discomforts in the tramadol withdrawal syndrome [9]. Alpha-2 adrenergic agonists are valuable for the management of withdrawal syndrome due to opioids by reducing the noradrenergic effects in the brain and all symptoms of withdrawal syndrome, such as anxiety, irritability, and restlessness in opioid-dependent patients [6]. Most of these agonists (clonidine and lofexidine, etc.)…”