Attention Allwell Providers - Opioid Potentiators
Date: 07/13/18
Thank you for your continued partnership with Allwell from Magnolia Health. We are committed to helping you and your patients combat the opioid epidemic present in many of our communities. With that in mind, we want to bring to your attention a list of opioid potentiators recently published by CMS.
Some medications when used in conjunction with opioids, enhance the opiate effect. The table below depicts the drugs highlighted by CMS, however it is not a comprehensive list of potentiators. In order to best protect the health and safety of your patients and to help combat the misuse and abuse of opioids, it is important to consider these medication classes when prescribing. Please bear in mind the interaction of an opioid and a potentiator to determine the risks and benefits of their combination.
Opioid Potentiators Table
CNS Depressants: | ||
Drug Class | Medication | Important Points |
Benzodiazepines | alprazolam, clonazepam, diazepam, lorazepam | · Both opioids and BZDs sedate users, suppress breathing and impair cognitive function. |
Muscle Relaxants | tizanidine, cyclobenzaprine, baclofen, carisoprodol* | · Increased risk for respiratory depression, coma, and death when used with opioids.
*The combination of carisoprodol, BZDs, and opioids results in a heroin-like high. |
Barbiturates | phenobarbital | |
BZD-like hypnotics | zolpidem, zaleplon, eszopiclone | |
Gabapentinoids | gabapentin, pregabalin | |
Antihistamines | promethazine | |
Antipsychotics | quetiapine | |
Pharmacokinetic Enhancers: | ||
Drug Class | Medication | Important Points |
HIV Drugs | ritonavir, atazanavir, indinavir, cobicistat | · CYP450 inhibition à increase in serum opioid concentration · Ultimately results in strong CNS depression. |
Antifungals | itraconazole, ketoconazole, posaconazole | |
Antibiotics | clarithromycin | |
Other Potentiators: | ||
Drug Class | Medication | Important Points |
Stimulants | dextroamphetamine, methylphenidate | · Extremely high abuse potential. · Used in combination to combat fatigue and sedation caused by high daily doses of opioids or to increase the analgesic effect. |
Thank you for the care that you provide to your patients and our members. Please reach out to our Provider Services team at 1-844-786-7711 with any questions you may have.