Naltrexone and Lorazepam Combination Therapy

Introduction to Precautions and Management

• The American Gastroenterological Association recommends naltrexone-bupropion ER is contraindicated in patients with seizure disorders 1
• The guideline society suggests abrupt discontinuation of benzodiazepines, including lorazepam, is an absolute contraindication for bupropion use due to dramatically increased seizure risk 3

Patient Monitoring and Management

• Blood pressure and heart rate must be monitored periodically, especially during the first 12 weeks of naltrexone-bupropion treatment, as recommended by the American Heart Association 1
• Liver function tests should be performed every 3-6 months for long-term naltrexone treatment, according to the American Association for the Study of Liver Diseases 4
• The American Academy of Neurology recommends assessing for seizure risk factors before initiating or continuing naltrexone-bupropion therapy 1

Contraindications and Special Considerations

• Current opioid use is an absolute contraindication for naltrexone-bupropion, as stated by the American Society of Addiction Medicine 1
• Uncontrolled hypertension is a contraindication for bupropion use, according to the American Heart Association 2
• Seizure disorders are a contraindication for bupropion use, as recommended by the American Academy of Neurology 1

Dosing Considerations

• The guideline society recommends reducing naltrexone-bupropion dose by half in moderate to severe renal impairment 3
• The maximum daily dose of bupropion component should be 150 mg in moderate to severe hepatic impairment, as suggested by the American Association for the Study of Liver Diseases 3