Strongest FDA Warnings Out on Opioid, Benzodiazapine Risks

The Food and Drug Administration (FDA) has issued its strongest warnings that prescription opioids and benzodiazapines pose major risks to users, especially if they are taken together or in combination with alcohol.

In a notice published at http://www.fda.gov/Drugs/DrugSafety/ucm518473.htm, the FDA told health care professionals to stop prescribing opioid cough medicines for patients taking benzodiazapines -- or other depressants of the Central Nervous System (CNS) including alcohol. They should prescribe opioids for pain only when other treatment options are inadequate.

Opioids — such as codeine, hydrocodone (HYSLINGA, NORCO, ZOHYDRO) and oxycodone (OXYCONTIN) — are widely prescribed for pain and cough. Benzodiazepines — such as diazepam (VALIUM) and alprazolam (XANAX) — are often used for anxiety, insomnia, seizures, and sleep problems.

Combinations of these drugs can cause extreme sleepiness, slowed or difficult breathing, coma, and death, the FDA said. Get details at the web site, and be sure to scroll down and click up several additional pages which explain the risks and list the dozens of opioids and benzodiazapines on the market.

The FDA said it now requires black-box warnings -- its strongest warnings -- on the dangers of combining opioid pain medications with benzodiazepines. Public Citizen’s Health Research Group lists most opioids as "Limited Use," noting that they are overprescribed and can be addictive. They list most benzodiazepines as "Do Not Use," with the exception of alprazolam, which is Do Not Use except for panic disorder.

Interested in more discussions like this? Go to the Chronic Pain Support Group.

kdoconnell2003 I was on Clemazopam on and off since January of 2018. I have used it steady (at .5 mg) for about a month now. I am withdrawing now, but I am experiencing blurry vision. I am taking Paxil 25mg CR and am now using Trazodone 50mg for sleep instead of Clemazopam.. A week ago my psychiatrist recommended melatonin at 9mg but it didn't work. Is there any discussion on blurred vision? Does melatonin cause blurred vision or is it the benzodiazapine? After withdrawing from a benzodiazepine, does your vision go back to normal? If so, how long does it take, or will it stay blurred?

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@kdoconnell2003

kdoconnell2003 I was on Clemazopam on and off since January of 2018. I have used it steady (at .5 mg) for about a month now. I am withdrawing now, but I am experiencing blurry vision. I am taking Paxil 25mg CR and am now using Trazodone 50mg for sleep instead of Clemazopam.. A week ago my psychiatrist recommended melatonin at 9mg but it didn't work. Is there any discussion on blurred vision? Does melatonin cause blurred vision or is it the benzodiazapine? After withdrawing from a benzodiazepine, does your vision go back to normal? If so, how long does it take, or will it stay blurred?

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Hello @kdoconnell2003- Welcome to Mayo Clinic Connect. You will notice that I moved your topic to this already existing discussion thread. Members here are talking about FDA warnings and Benzo risk. There is a wealth of information here. Feel free to ask questions to the participants in this group.

Have you talked with your doctor about your blurred vision?

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Many doctors know very little about Benzo tapers. If done too quickly a person can seizure and die. Alcohol is the only other drug a person can die if taken off too quickly.
Benzo titration should be very slow so that there isn’t a protracted withdrawal. A doctor can have a compounding pharmacy make the Benzo into a liquid for a smoother slower taper. There are 140 side effects recognized that can occur during a titration and even after the last dose.
I was prescribed Valium for muscle spasms 17 years ago. Been very difficult with seizures, full body pain, mania, feeling very ill, insomnia, anxiety and much more. A more knowledgeable and caring psychiatrist finally had the Valium made into a liquid. Am down to 3.95mg daily. I also have chronic back and pelvic pain pain. I am hoping to get off Valium in 2022. It has been a agonizing journey for me.

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CDC proposes new guidelines for opioid use. The proposed rule is in the Federal Register for public comment. May want to add your comments, recommendations, etc. to the proposed rule.

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How safe is .5 Xanax 3 X daily?

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@kenc

CDC proposes new guidelines for opioid use. The proposed rule is in the Federal Register for public comment. May want to add your comments, recommendations, etc. to the proposed rule.

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It depends on the dosage. One cannot limit without that consideration. Also everyone is different and therefore the amount of medications they can tolerate/how much it takes for them to reach the level the need is different. A blanket statement is not accurate to make for everyone. Therefore the doctor needs to determine the needs for each patient's needs.

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@kathy5645

Many doctors know very little about Benzo tapers. If done too quickly a person can seizure and die. Alcohol is the only other drug a person can die if taken off too quickly.
Benzo titration should be very slow so that there isn’t a protracted withdrawal. A doctor can have a compounding pharmacy make the Benzo into a liquid for a smoother slower taper. There are 140 side effects recognized that can occur during a titration and even after the last dose.
I was prescribed Valium for muscle spasms 17 years ago. Been very difficult with seizures, full body pain, mania, feeling very ill, insomnia, anxiety and much more. A more knowledgeable and caring psychiatrist finally had the Valium made into a liquid. Am down to 3.95mg daily. I also have chronic back and pelvic pain pain. I am hoping to get off Valium in 2022. It has been a agonizing journey for me.

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Withdrawal is a danger to those with scitzophrenia and could be for others.

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@predictable

An elderly woman I knew quite well died in 2006, still addicted to Lorazepam, a benzodiazepine originally prescribed for her when her husband was mortally burned in a home fire in 1980. For those 26 years, she remained addicted although her emotional health had been restored and stabilized within months of her husband's death. A series of personal care physicians provided her Lorezepam prescriptions every time she requested them . . . for 26 years. This is my personal experience with benzodiazipines -- and the cause of my personal resolve never to take the damn stuff!

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I was prescribed klonopin for 25 years after a divorce. I could not sleep, had 2 little kids, was in counseling and this is what was prescribed to help with sleep and anxiety. I appreicated it so much - it was magical - I slept like a baby and it reduced my anxiety to nothing. Much much later, I read about the side effects and the impact on the brain and found a doctor to help me safely taper and it took me over a year to get off of it. I notice significant memory loss and I'm 100% sure that most of that is from the drug (some due to age, I'm sure). I wish I'd even heard of it and don't understand why it was so freely prescribed year after year. If a doctor prescribes it, it's important to understand the side effects and to know how long it's safe to take it - I believe it's no more than 4 weeks.

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@kdoconnell2003

kdoconnell2003 I was on Clemazopam on and off since January of 2018. I have used it steady (at .5 mg) for about a month now. I am withdrawing now, but I am experiencing blurry vision. I am taking Paxil 25mg CR and am now using Trazodone 50mg for sleep instead of Clemazopam.. A week ago my psychiatrist recommended melatonin at 9mg but it didn't work. Is there any discussion on blurred vision? Does melatonin cause blurred vision or is it the benzodiazapine? After withdrawing from a benzodiazepine, does your vision go back to normal? If so, how long does it take, or will it stay blurred?

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I had blurry vision the whole time I was tapering off Xanax. It does get better once you’ve fully tapered off.

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@kathy5645

Many doctors know very little about Benzo tapers. If done too quickly a person can seizure and die. Alcohol is the only other drug a person can die if taken off too quickly.
Benzo titration should be very slow so that there isn’t a protracted withdrawal. A doctor can have a compounding pharmacy make the Benzo into a liquid for a smoother slower taper. There are 140 side effects recognized that can occur during a titration and even after the last dose.
I was prescribed Valium for muscle spasms 17 years ago. Been very difficult with seizures, full body pain, mania, feeling very ill, insomnia, anxiety and much more. A more knowledgeable and caring psychiatrist finally had the Valium made into a liquid. Am down to 3.95mg daily. I also have chronic back and pelvic pain pain. I am hoping to get off Valium in 2022. It has been a agonizing journey for me.

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One can get the liquid version of their benzodiazepine at any pharmacy. It doesn’t need to be compounded and it’s inexpensive.

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