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The Food and Drug Administration has issued new warnings about the dangers of combining medication for opioid addiction with antianxiety medicines and other drugs that also slow breathing and brain activity.
According to the FDA, mixing such drugs can cause difficulty breathing, coma or death, and should be done with caution.
The agency said a growing number of people fighting opioid addiction with methadone or buprenorphine also take other drugs that slow action of the central nervous system. The warning lists several dozen brand-name and generic drugs that could be risky, including Ambien and Lunesta for insomnia, Valium and Xanax for anxiety, muscle relaxants Soma and Zanaflex, and antipsychotics Abilify, Invega and Saphris.
The FDA stressed that treating opioid addiction with medication can outweigh those risks and is crucial to curbing the U.S. opioid epidemic, along with counseling, rehabilitation and other support.
"Careful management of the patient and coordination of care is recommended," rather than denying use of methadone or buprenorphine, FDA Commissioner Scott Gottlieb wrote in the warning.
The agency recommends that doctors develop detailed treatment plans, warn patients on addiction treatments about the dangers of taking multiple drugs that depress brain activity, and try to taper them off the other drugs.
Buprenorphine and methadone work by binding to the same brain areas as opioids, reducing cravings and withdrawal without producing a high. The FDA is requiring makers of those two medications to update their package inserts with information about the risks.