Naltrexone and Chlordiazepoxide Combination Therapy

Key Clinical Considerations

• The American Gastroenterological Association guidelines do not list benzodiazepines like chlordiazepoxide as contraindications for naltrexone-bupropion ER, which includes contraindications such as uncontrolled hypertension, seizure disorders, chronic opioid therapy, and use with MAO inhibitors 1, 2, 3.
• The FDA-approved safety profile for naltrexone-bupropion ER does not identify benzodiazepines as problematic co-medications, according to the American Diabetes Association 4, 5, 6.

Important Caveats

• The American Heart Association recommends monitoring for excessive sedation, particularly during dose titration of either medication, as benzodiazepines cause CNS depression and sedation 3, 5.
• The American Psychiatric Association notes that naltrexone-bupropion ER carries a black box warning for suicidal behavior/ideation in patients younger than 24 years with depression, and recommends monitoring psychiatric symptoms closely when using both medications 4, 5, 6, 7.

Practical Recommendations

• The National Institute on Alcohol Abuse and Alcoholism suggests that the combination is safe to prescribe when the patient requires both medications for legitimate clinical indications, such as alcohol withdrawal management transitioning to relapse prevention, or obesity treatment in a patient with anxiety requiring benzodiazepine therapy 1.
• The American Academy of Neurology recommends avoiding the combination in patients with uncontrolled hypertension, seizure disorders, or chronic opioid therapy, and reducing the dose by half in moderate to severe renal impairment 1, 2, 3, 6, 7.