title: Combined abuse of clonidine and amitriptyline in a patient on buprenorphine maintenance treatment.
abstract: Buprenorphine/naloxone maintenance therapy is often prescribed in primary care to treat opioid dependence. Previous reports have described concomitant abuse of opioids and clonidine. In this case, a primary care patient on buprenorphine/naloxone maintenance therapy demonstrating altered mental status, hallucinations, falls, and rebound hypertension was found to be concomitantly abusing clonidine and amitryptyline, which share metabolic pathways with buprenorphine. Clinicians should be aware of patients' combining amitryptyline, clonidine, and gabapentin with buprenorphine to achieve a mood altering state, avoid co-prescribing them if possible, and maintain communication with pharmacies and other providers when they are prescribed.
authors.affiliation: From the Department of Family Medicine (JPS, TD, EJS, HC, JAJ), Medical Center of Central Georgia and Mercer University School of Medicine, Macon, GA; and Department of Psychiatry and Behavioral Medicine, Mercer University School of Medicine, Macon, GA (JAJ).
authors.forename: J Paul
authors.initials: JP
authors.lastname: Seale
authors.forename: Trent
authors.initials: T
authors.lastname: Dittmer
authors.forename: Erika J
authors.initials: EJ
authors.lastname: Sigman
authors.forename: Holly
authors.initials: H
authors.lastname: Clemons
authors.forename: J Aaron
authors.initials: JA
authors.lastname: Johnson
mesh_terms: D000639:Amitriptyline; D000929:Antidepressive Agents, Tricyclic; D000959:Antihypertensive Agents; D002047:Buprenorphine / Q000627:therapeutic use*; D003000:Clonidine; D005260:Female; D006801:Humans; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000150:complications / Q000188:drug therapy*; D019966:Substance-Related Disorders / Q000150:complications*
chemical_list: D000929:Antidepressive Agents, Tricyclic; D000959:Antihypertensive Agents; D000639:Amitriptyline; D002047:Buprenorphine; D003000:Clonidine