Lofexidine (Lucemyra™)

SELF ADMINISTRATION

Indications for Prior Authorization:

  • Indicated for mitigation of opioid withdrawl symptoms to facilitate abrupt opioid discontinuation in adults.

Patients must meet the following criteria for the indication above:

  • Patient is 18 years of age and older, AND
  • Diagnosis of opioid dependence or opioid use disorder, AND
  • Prescribed by or in consultation with a specialist (e.g. pain management, addiction psychiatry, emergency medicine), AND
  • Member is undergoing abrupt opioid discontinuation and chart notes document a medically appropriate reason why an opioid taper cannot be used, AND
  • Patient has tried and failed Clonidine or experienced unacceptable toxicity and/or inadequate efficacy as confirmed by chart note documentation

Dosing:

  • Starting dosage: 0.54mg (three 0.18mg tablets) four times daily during peak withdrawl symptoms (generally 5-7 days following last use of opioid)
  • Max total daily dose: 2.88mg (16 tablets)
  • Max 0.72mg (4 tablets) per dose
  • Hepatic Impairment:
    • Mild Impairment: 3 tablets four times daily
    • Moderate Impairment: 2 tablets four times daily
    • Severe Impairment: 1 tablet four times daily
  • Renal Impairment:
    • eGFR 30-89.9mL/min: 2 tablets four times daily
    • eGFR < 30mL/min: 1 tablet four times daily

Approval:

  • Initial: 7 days
  • Renewal: 7 days
  • Total duration of therapy 14 days

Last review date: May 28, 2019