The opioid addiction medications buprenorphine and methadone should not be withheld from patients who are taking benzodiazepines or other drugs that depress the central nervous system, the Food and Drug Administration advised in a safety alert posted Sept. 20.
The combined use of these medication-assisted treatment (MAT) drugs and central nervous system (CNS) depressants can lead to serious side effects. But the harm associated with opioid addiction that remains untreated usually outweighs those risks, the agency said. After reviewing this issue, the FDA said, it is requiring that this information be added to the drug labels of buprenorphine and methadone in addition to “recommendations for minimizing the use of [MAT] drugs and benzodiazepines together.”
The agency’s safety alert encouraged health professionals to develop a treatment plan for patients who are taking MAT drugs in combination with CNS depressants. The recommendations included educating patients about the risks of combined use of these drugs, “including overdose and death”; considering other treatment options for patients taking benzodiazepines for anxiety or insomnia; monitoring patients for illicit drug use, “including urine or blood screening”; communicating with other prescribers so that they know about patients’ buprenorphine or methadone treatment; and trying to taper the use of the benzodiazepine or CNS depressant to eventual discontinuation if possible.
Discontinuing MAT drugs is a goal, but patients might need medication-assisted treatment indefinitely. “Use should continue for as long as patients are benefiting and their use contributes to the intended treatment goals,” the alert said.
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