Introduction: Lofexidine is one therapeutic option used for treating the onslaught of sympathetic outflow that typically commences upon induction of opiate withdrawal. It was approved for opiate detoxification in the UK, most of EU, and a select few countries worldwide during the 1980s and the 90s. Within the US and Canada, however, it remains an experimental drug.Areas covered: The following article highlights lacunae in extant knowledge about the molecular pharmacology of lofexidine. Furthermore, the article provides a brief discussion on the nature and shortcomings of clinical trials for this drug that have been conducted over the past 30 years across the world. It also provides a discussion of the market factors and regulatory considerations responsible for the rather limited use of lofexidine thus far.Expert opinion: Many lessons can be learned from the 40-year-long development of lofexidine. Indeed, unless there is an urgent need to address an unmet and/or immediate health threat, preclinical development is dictated by pharmacoeconomic considerations. Lofexidine would likely have been excluded for further development in this day and age given the existence and value of clonidine as well as the lack of insurance coverage for opiate addiction. It should be noted, however, that although there have been many oversights in the past, current experimentation and clinical trials are beginning to address the mistakes made through the exploration of single enantiomers and controlled-release preparations.
Bibliographical noteFunding Information:
A partnership between US WorldMeds Inc. and Britannia Pharmaceuticals (which owns the Britlofex brand) was brokered by the National Institutes of Drug Abuse (NIDA) at the NIH, leading to a relaunch of clinical effort in the late 2000s. Before this recent effort is discussed, it will be worth-while to review clinical trials that took place in the 1980s and 90s.
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- Adrenergic receptors
- Enantioselective synthesis
- Imidazole receptors
- Preclinical work