The FDA has approved lofexidine (Lucemyra – US WorldMeds/Salix), a centrally acting alpha₂ receptor agonist, to manage withdrawal symptoms in adults abruptly stopping opioid use. Available in the UK since 1992, lofexidine is the first nonopioid to be approved in the US for management of opioid withdrawal symptoms. Clonidine (Catapres, and generics), another central alpha₂ receptor agonist, has been used off-label for this indication for many years.

STANDARD TREATMENT — The partial opioid agonist buprenorphine is the drug of choice for management of opioid withdrawal in most patients.1 It is comparable in efficacy to the full opioid agonist methadone, but it is safer and does not need to be obtained through a licensed outpatient treatment program. Clonidine is less effective than methadone or buprenorphine; it is most useful as an adjunct to an opioid agonist or as an alternative in settings...  Continue reading

The FDA has approved Biktarvy (Gilead), a once-daily, fixed-dose combination of bictegravir, a new integrase strand transfer inhibitor (INSTI), and the nucleoside reverse transcriptase inhibitors (NRTIs) emtricitabine and tenofovir alafenamide (TAF), for treatment of HIV-1 infection in adults. The new combination is indicated for use in patients who are antiretroviral-naive or who have been virologically suppressed on a stable antiretroviral regimen for ≥3 months with no history of treatment failure and no known substitutions associated with resistance to any component of the combination.

Bictegravir is the fourth INSTI to become available in the US. Emtricitabine and TAF are also available together as Descovy1 and in fixed-dose combinations with the ... Continue reading