The FDA recently approved first-time generics for two drugs that may impact patients taking opioid pain medications.
Lucemyra™ (lofexidine) tablets are indicated for the mitigation of opioid withdrawal symptoms to facilitate abrupt opioid discontinuation. Typically, 0.18 mg tablets of lofexidine tablets are taken orally four times a day at five-to-six-hour intervals for up to 14 days, with dosing guided by symptoms. Discontinuation of this drug should be a gradual dose reduction from two-to-four days.
Adverse reactions include orthostatic hypotension (a drop in blood pressure when standing up or sitting down), bradycardia, hypotension, dizziness, somnolence (drowsiness), sedation, and dry mouth. Additionally, patients who effectively discontinue opioids are at an increased risk of opioid overdose should they resume opioid use.
Relistor® (methylnaltrexone bromide) injection is an opioid antagonist indicated for the treatment of opioid-induced constipation in adults with chronic non-cancer pain. According to the drug label, the recommended dose is 12 mg subcutaneously once daily. Treatment should be discontinued if opioid pain medications are also discontinued.
Patients receiving opioids for less than four weeks may be less responsive to this drug. It is recommended to discontinue all other laxative therapies prior to starting these injections. Injections should be reevaluated when an opioid regimen is adjusted.
Adverse reactions include abdominal pain, flatulence, nausea, dizziness, and diarrhea. Methylnaltrexone bromide injections are contraindicated in patients with known or suspected mechanical gastrointestinal obstruction and at increased risk of recurrent obstruction.
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