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• W2149204775 abstract "We read with interest the recent article by Heather Martin entitled “The Possible Consequences of Combining Lorazepam and Buprenorphine/Naloxone: A Case Review.”1Martin HA The possible consequences of combining Lorazepam and buprenorphine/naloxone: a case review.J Emerg Nurs. 2011; 37: 200-202Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar It is an interesting case study and we would like to express our thoughts on the drug interactions among benzodiazepine and buprenorphine/naloxone based on the literature review. In this case study, the author claimed that administering a benzodiazepine depressant to patients taking buprenorphine/naloxone can be life-threatening, and suggested that benzodiazepines should be avoided when treating anxiety in patients taking buprenorphine/naloxone. Benzodiazepine is widely used in the world for anxiety and insomnia. Its use and abuse is even more widespread in populations of illegal drug abusers.2Chen KW Berger CC Forde DP et al.Benzodiazepine use and misuse among patients in a methadone program.BMC Psychiatry. 2011; 11: 90Crossref PubMed Scopus (102) Google Scholar The synergistic toxic effects of benzodiazepine with buprenorphine/naloxone might depend on the types of benzodiazepines. Lorazepam seldom causes death by itself but interacts with buprenorphine, methadone, and other opiates or cocaine with sometimes fatal results.3Lintzeris N Nielsen S Benzodiazepines, methadone and buprenorphine: interactions and clinical management.Am J Addict. 2010; 19: 59-72Crossref PubMed Scopus (85) Google Scholar The author discussed the interaction between benzodiazepine and buprenorphine but did not mention the interaction between benzodiazepine and naloxone. However, most recent clinical research shows that naloxone might directly interact with benzodiazepine and have benefit effect in benzodiazepine intoxication, which is very interesting and important to know for the clinical use of these drugs. Naloxone is well known for the treatment of addiction to opiates, as well as ethanol and some other drug intoxication. Animal studies show that naloxone directly antagonizes the GABA/benzodiazepine receptor function in the rat. Electrophysiological data show that GABA-induced inhibition of neuronal firing in the rat brain can be antagonized by naloxone.4Dingledine R Iversen LL Breuker E Naloxone as a GABA antagonist: evidence from iontophoretic, receptor binding and convulsant studies.Eur J Pharmacol. 1978; 47: 19-27Crossref PubMed Scopus (301) Google Scholar Furthermore, in experimental animals, naloxone antagonizes benzodiazepine-induced various behaviors, such as hyperdipsia, hyperphagia, anticonflict effects, and anxiolytic-like effects.5Soubrié P Jobert A Thiebot MH Differential effects on naloxone against the diazepam-induced release of behavior in rats in three aversive situations.Psychopharmacology (Berl). 1980; 69: 101-105Crossref PubMed Scopus (67) Google Scholar, 6Cooper SJ Effects of opiate antagonists and of morphine on chlordiazepoxide-induced hyperdipsia in the water-deprived rat.Neuropharmacology. 1982; 21: 1013-1017Crossref PubMed Scopus (22) Google Scholar, 7Belzung C Agmo A Naloxone blocks anxiolytic-like effects of benzodiazepines in Swiss but not in Balb/c mice.Psychopharmacology (Berl). 1997; 132: 195-201Crossref PubMed Scopus (28) Google Scholar, 8Agmo A Galvan A Heredia A et al.Naloxone blocks the antianxiety but not the motor effects of benzodiazepines and pentobarbital: experimental studies and literature review.Psychopharmacology (Berl). 1995; 120: 186-194Crossref PubMed Scopus (53) Google Scholar Recent clinical research shows that naloxone improves clinical symptoms and signs of benzodiazepine poisoning, including lethargy, weakness, ataxia, dysarthria, and decreased consciousness level, in patients without a history of illegal drug use.9Solhi H Mostafazadeh B Reza Khoddami Vishteh H et al.Benefit effect of naloxone in benzodiazepines intoxication: findings of a preliminary study.Hum Exp Toxicol. 2011; 30: 535-540Crossref PubMed Scopus (11) Google Scholar These animal and clinical research studies provided direct evidence for the interaction between benzodiazepine and naloxone. This case study and literature review by Heather Martin provided useful information for the clinical use of benzodiazepine and buprenorphine/naloxone. However, the exact interactions and mechanisms among benzodiazepine, buprenorphine, and naloxone need further clinical and animal studies. The Possible Consequences of Combining Lorazepam and Buprenorphine/Naloxone: A Case ReviewJournal of Emergency NursingVol. 37Issue 2PreviewAdministering a benzodiazepine depressant to patients taking buprenorphine/naloxone can be life-threatening. Unfortunately, many ED health care providers are unaware of this potentially lethal combination. The following case study illustrates how these medications, when administered together, can adversely affect patient outcome. Full-Text PDF" @default.
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• W2149204775 title "Interactions Among Benzodiazepine and Buprenorphine/Naloxone" @default.
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