Lofexidine Hydrochloride and Oxacillin Sodium

• 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.

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

  Oxacillin Sodium ADD-Vantage, Bactocill

Treatment of infections caused by, or suspected of being caused by, susceptible penicillinase-producing staphylococci, including respiratory tract, skin and skin structure, bone and joint, and urinary tract infections and meningitis or bacteremia. A drug of choice for these infections.

Treatment of native valve or prosthetic valve endocarditis caused by susceptible staphylococci. A drug of choice; used with or without gentamicin for native valve endocarditis and used in conjunction with rifampin and gentamicin for prosthetic valve endocarditis.

If used empirically, consider whether staphylococci resistant to penicillinase-resistant penicillins (oxacillin-resistant [methicillin-resistant] staphylococci) are prevalent in the hospital or community. (See Staphylococci Resistant to Penicillinase-resistant Penicillins under Cautions.)

Has been used for perioperative prophylaxis in patients undergoing neurosurgery or cardiovascular or orthopedic surgery associated with high risk of staphylococcal infections. Not considered a drug of choice.