Benzodiazepines, methadone and buprenorphine: interactions and clinical management.
Benzodiazepines (BZDs) are widely used by heroin users not in treatment, and by patients in methadone and buprenorphine (BPN) treatment. This review examines the epidemiology of BZD use by opioid users, and the range of harms that are associated with BZD use in this group, including the association of BZD use with opioid-related mortality. Preclinical and clinical data regarding pharmacokinetic and pharmacodynamic interactions between methadone, buprenorphine, and BZDs are reviewed. An overview of treatment approaches for managing BZD use in this population is presented, including strategies for minimizing abuse and addressing BZD dependence.
Sydney South West Area Health Service and University of Sydney, Sydney, Australia. nlintzer@mail.med.usy.edu.au
Nicholas
N
Lintzeris
Suzanne
S
Nielsen
D001569:Benzodiazepines / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000494:pharmacology; D002047:Buprenorphine / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000494:pharmacology; D002985:Clinical Protocols; D004347:Drug Interactions; D006801:Humans; D008691:Methadone / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000494:pharmacology; D009293:Opioid-Related Disorders / Q000150:complications / Q000534:rehabilitation*; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control* / Q000534:rehabilitation*
D001569:Benzodiazepines; D002047:Buprenorphine; D008691:Methadone