Alcohol Withdrawal Syndromes: Clinical Management with Lofexidine

Abstract

Sixty-three mainly male alcoholics were randomly assigned to placebo or lofexidine treatment for 48 hr shortly after admission to the hospital. Their starting points were similar regarding their semiquantitative estimates of alcohol withdrawal symptoms (AWS). Their demographics, histories of past alcohol use, physical findings, and laboratory abnormalities usually associated with alcoholism were similar. Starting 3 hr after 0.4 mg of oral lofexidine, which was given every 6 hr as eight doses, the AWS scores were significantly lower than those of the placebo group. Hypotension was the strongest finding. Six placebo recipients had to be prematurely interrupted due to increasing or intolerable alcohol withdrawal symptoms and switched to a benzodiazepine. Only one lofexidine recipient was prematurely interrupted, due to transient hallucinations. The study has a large placebo effect, as both groups of patients rated the treatment process very highly. Lofexidine, an alpha 2-adrenergic agonist, was superior to placebo in alcohol withdrawal. This drug, as with its analogue clonidine, may represent a new and important pharmacological treatment for alcohol withdrawal symptoms.

Episodic and Working Memory Deficits in Alcoholic Korsakoff Patients: The Continuity Theory Revisited

“…All patients were still at an early stage of abstinence (11.18 ± 11.75 days of sobriety prior to inclusion,), as it is now clear that episodic memory and working memory recover with abstinence and may even return to normal (Fein et al, 2006;Rourke and Grant, 1999). We only selected patients who had already been weaned off alcohol, as verified by means of the Cushman score (Cushman et al, 1985), to decrease the likelihood of acute alcohol withdrawal effects. AL were interviewed to specify the age at which they had had their first alcoholic drink (16.67 ± 4.13), their age at the onset of alcoholism (28.63 ± 11.04), the length of time they had drunk to excess (20.32 ± 8.08 years) and their usual daily alcohol consumption (18.91 ± 10.16 ''standard drinks'' per day, i.e., any drink that contains approximately 10 g of pure alcohol).…”

Animal models of the anxiogenic effects of ethanol withdrawal

“…The α 2 agonists clonidine [Baum- gartner and Rowen, 1987;Cushman, 1987;Robinson et al, 1989;Wilkins et al, 1983] and lofexidine [Cushman et al, 1985] are considered to be effective in the management of mild to moderate EW symptoms. It is odd, given the frequency of the use of clonidine in the treatment of EW, that very little research has been conducted on its effects in animal models.…”

Confusion et agitation en réanimation — Mécanismes et diagnostic

“…Il est recommandé de monitorer ces patients par un score tel que le Revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar) [26,27] : un score inférieur à 8 signe un tableau clinique minime, un score entre 8 et 15 signifie la présence d'une dysautonomie marquée et un score supérieur à 15 est prédictif de la survenue de convulsions et de délire. Le score de Cushman [28] est également couramment utilisé en France.…”

“…Les syndromes de sevrage à des substances telles que la cocaïne et les amphétamines, qui inhibent la recapture des catécholamines, et les cannabinoïdes existent en réanima-tion, mais sont mal caractérisés dans les études à ce jour [28].…”