Lincomycin Injection and Lofexidine Hydrochloride

• Generic Name: lincomycin
• Dosage Forms: injection, solution
• Other Brand Names: Lincocin, Lincorex, L-Mycin, Bactramycin

Treatment of serious infections caused by susceptible staphylococci, Streptococcus pneumoniae, and other streptococci. Because of more potent antibacterial activity, clindamycin usually preferred when a lincosamide antibiotic indicated for treatment of these infections.

Reserve for treatment of serious infections when less toxic alternatives cannot be used (e.g., penicillin-allergic patients or other patients for whom a penicillin is inappropriate). Has been associated with potentially fatal colitis (see Superinfection/Clostridium difficile-associated Diarrhea and Colitis [CDAD] under Cautions); consider nature of the infection and suitability of less toxic alternatives (e.g., erythromycin).

May be used concomitantly with other anti-infectives when indicated.

Certain infections may require incision and drainage or other indicated surgical procedures in addition to anti-infective treatment; use of lincomycin does not eliminate need for surgical procedures when indicated.

Do not use for treatment of meningitis because of inadequate CNS penetration following parenteral administration.

• Generic Name: lofexidine
• Dosage Forms: n.a.
• Other Brand Names: Lucemyra

Used for mitigation of opiate withdrawal symptoms to facilitate abrupt opiate discontinuance.

Not a treatment for opiate use disorder (OUD); use in patients with OUD only in conjunction with a comprehensive treatment program.

In patients with OUD, opiate withdrawal management (i.e., detoxification) generally involves short-term use of tapering dosages of buprenorphine (opiate partial agonist) or methadone (full opiate agonist) to reduce withdrawal symptoms. However, α2-adrenergic agonists (e.g., lofexidine, clonidine) also used for symptomatic relief of noradrenergic-mediated opiate withdrawal symptoms (e.g., lacrimation, sweating, shivering, rhinorrhea) in inpatient and outpatient settings and may allow for withdrawal over a shorter period of time.

α2-Adrenergic agonists appear to be less effective than buprenorphine or methadone for management of opiate withdrawal; some experts suggest α2-adrenergic agonists may be most useful in withdrawal management as adjuncts to opiate agonists or partial agonists, to facilitate transition to opiate antagonist (naltrexone) treatment for relapse prevention, or when opiate agonist or partial agonist therapy is contraindicated, unacceptable, or unavailable.

Concomitant supportive therapy for other withdrawal symptoms (e.g., abdominal cramping, diarrhea, nausea and vomiting, muscle spasms, anxiety or restlessness, insomnia) often used.

Several small comparative studies suggest lofexidine and clonidine have similar efficacy in managing opiate withdrawal symptoms but lofexidine may cause less hypotension. Must also consider greater cost of lofexidine compared with off-label clonidine use.

Because of potential for hypotension and bradycardia, some experts state that α2-adrenergic agonists are not drugs of choice for opiate withdrawal management in geriatric patients or patients with coronary insufficiency, ischemic heart disease, bradycardia, or cerebrovascular disease.

In patients receiving long-term opiate analgesia, withdrawal symptoms generally managed by slow tapering of the opiate analgesic dosage.