An opioid-dependent patient completing detoxification experiences intense lacrimation, diarrhoea, piloerection, and cramps. Which drug class directly suppresses these autonomic manifestations of withdrawal?

• A Beta-1 selective blockers such as metoprolol
• B Selective serotonin reuptake inhibitors such as fluoxetine
• C Central alpha-2 adrenergic agonists such as clonidine and lofexidine ✓
• D Anticholinergics such as glycopyrrolate

Explanation

Opioid withdrawal reflects disinhibition of noradrenergic neurons in the locus coeruleus once chronic opioid suppression is removed. Alpha-2 agonists like clonidine and lofexidine stimulate presynaptic alpha-2 receptors, dampening this noradrenergic outflow and relieving autonomic symptoms. They do not treat craving, and lofexidine is preferred where hypotension from clonidine is a concern.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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