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.
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Baclofen, effexor, tramadol, trazadone, xanax, percocet, hydromorphone, hydrocodone, tegratol, adivan this list goes on and on I know we as a family need help in dealing with this however I am not sure just where that help is just yet.
It sounds to me like a good personal physician needs to intervene and look at all sides of issue. I can't believe a pain mgmt. Dr. is prescribing benzos and Gail may be correct. sometimes complete withdrawal is not the answer. Is the family member on any kind of oxygen or have they had any breathing problems? My taper schedule for benzos was 6mg to 5 mg to 4mg and that is where I am now. I expect to go down about 1 mg/mo. from here forward. My opioid level fluctuates based on the condition of my pancreas, but is fairly low right now. It is not fair for me to say the pain mgmy Dr. should not prescribe benzos because I am not a Dr and don't have the knowledge to make that statement.
I can say after reading through all of these comments that it is clear that we are definitely not all wired the same. Some of these I have not been prescribed. The Gabapentin at 1200 mg./day I had all of the rare, but serious side effects. I had no trouble going off of this medication. I have been on benzos in the past for anxiety and decided on my own to taper off. As for pain relief the only thing that has helped is Hydrocodone without the dreadful side effects. Due to all the restrictions now on opiates I hesitate to ask the pain specialist, but may do so as nothing else has helped. Gets very confusing and I have had so many negative reactions to tramadol, trazadone, effexor and numerous other synthetic medications I have up to now tried to to tough things out. I am one who has the rare and severe side effects to medications that help others. Can say I am becoming discouraged with pain that keeps me from doing some of the things I enjoy. Plan to speak with the pain specialist as the stalwart part of me is becoming most discouraged.
I know many of us are living with pain, anxiety, depression that robs us of quality of life.
I started taking Klonopin in January of 2006, at 1mg, for anxiety disorder. I was taking 450mg of Wellbutrin already. This was before peripheral neuropathy entered my life.
The first few years with neuropathy I didn't need any medication, but around three years ago, I began experiencing increasing pain in my feet. I tried every medication for neuropathy, and then the neurologist recommended seeing a pain specialist. He took me through a bunch of meds that are off label for neuropathy, but are known to help some people. Nothing was helping. In the meantime, my pcp had me start taking morphine sulfate contin, and over the course of a year or so, I gradually worked up to 30mg tid. I finally found relief from the pain.
Last year I had a spinal cord stimulator implant in June and it reduced my pain by 80%. After that, I weaned off the morphine, to figure out if it was the morphine or Cymbalta that was helping my residual pain. After being off the morphine for 2-3 weeks, I knew that it was the medication I needed. I later weaned off the Cymbalta and didn't observe any effect, positive or negative, on the neuropathy pain. When I restarted morphine, I was able to get relief at 15mg bid.
Over the past couple of months, I've been having increased pain, and the stimulator is adjusted to its strongest setting, so I plan to ask my doctor to increase the morphine, beginning with adding a third pill at lunch. That's still a relatively low dose.
Back to the Klonopin, I tried several years ago to wean off it and went from 1mg to .75mg. After a few sleepless nights, I gave up. One of my doctors recommended that I continue taking it because it keeps me from acting out my dreams, specifically leg motion – read that, kicking my wife. She doesn't want me to stop taking the Klonopin. But, as I said, it's only 1mg.
My takeaway from the opioid/benzodiazepine discussion is that I will continue taking them because morphine is my last resort. I've run out of options. I think that my BIPAP will lower the risk of stopping breathing.
Cool Gail enjoy
I agree with @ parus in regards to everyone being different and that is what I hate about the FDA and DEA making blanket pronouncements. They serve to scare physicians into not doing what is in their patient's best interests. When I was a financial advisor, the first SEC rule was "know your client". I assume physicians (good ones) do the same and should know exactly what will work for them even if developed through trial and error. I think the idea of a specialist for everything limits this relationship and wish there was a medical degree for a "one stop shop" or at least offices designed for one of each and group reviews, which is how I believe the best practices medical facilities handle treatment. Anyone ever had the genetic profiling done by either a MD or Psych.? Eventually, I think this will be almost as common as routine blood work to at least point toward the medication(s) that will serve each one the best.
I've been interested in the genetic testing for medications for myself as I have bad reactions to lots of medications. Posted below is a link to the Mayo Education site that explains the simple process for having Genetic Testing for Medicines. You can even find out from Mayo what the costs would be. Of course the costs will differ for each place doing the tests. It sounds as if many of us have been guinea pigs long enough.
I know there are tests for antidepressants, but I don't know if there are tests for pain medications or other meds. You can ask you PCP to test you and find out what medications they can test for. It sure beats going through taking multiple meds and paying for them when they don't work for you. Im going to talk with my doctor about having this test for my antidepressant. Be sure to read the documentation as it contains information about insurance, etc. I hope this is helpful.
These comments and this forum is very helpful, hopefully optimistic.
Well, isn't that wonderful for me. I'm 72 with insurable pain disease. What am I supposed to do?
At m point of pain, don't care about stopping breathing. At least my pain will stop and I won't be paralyzed.