Cross Addictions and Safe Medications

Cross Addiction and Prescription drugs
One of the relapse pathways we struggle with in chemical and alcohol dependencies is exposing the meso-limbic system or the hypothalamus to drugs or chemicals that can lead to a return to the primary drug of dependency. This is commonly referred to as cross-addiction.

For example, you may realize that you are an alcoholic, and cannot have any form of alcohol, but if you go see your doctor for insomnia, pain, anxiety, etc., he may give you perfectly good medications, and be a well-meaning doctor, but some of those medicines will lead you right back to alcohol. In an effort to try and help you when you leave here, we have compiled a list of acceptable safe medications and have tried to include classes or individual drugs that we consider dangerous in the addicted patient. We have broken this down by diagnoses that are most commonly used in a primary care setting. It is in no way complete, meaning not every drug is listed. The FDA approved list of drugs numbers in the thousands. So, in an effort to keep the list manageable, we have listed the disease or diagnosis with a list of safe or acceptable medications. In some cases we have included drugs that we know lead to increased risk of relapse. We have listed the chemical to avoid up front for easy review when discussing medications with your doctor or seeking over the counter medications.

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Chemicals to Avoid
alcohol
alprazolam
amitriptyline
amobarbital sodium
amphetamine
atropine
attapulgite
benzphetamine
brompheniramine
butabarbital
butorphanol
carisoprodol
chloral hydrate
chlordiazepoxide
chlormezanone
chlorpheniramine
chlorpromazine
clonazepam
clorazepate
codeine
cyclobenzaprine
cyproheptadine
dexchlorpheniramine
dexfenfluramine
dexmethylphenidate
dextroamphetamine
dextromethorphan
diazepam
diethylpropion
diethylpropion hydrochloride
dihydrocodeine
diphenhydramine
diphenoxylate
dipotassium chlorazepate
doxepin
doxylamine succinate
ephedrine
estazolam
eszopiclone
ethchlorvynol
fenfluramine
fentanyl
flurazepam
glutethimide
halazepam
homatropine
hydrocodone
hydromorphone
ketamine
levorphanol
lisdexamfetamine
lorazepam
mazindol
meperidine
mephobarbital
meprobamate
methadone
methamphetamine
methylphenidate
morphine
nicotine
nitrous oxide
opium
oxazepam
oxycodone
oxymorphone
paraldehyde
pentobarbital
perphenazine
phendimetrazine
phenobarbital
phentermine
phenylephrine
phenylpropanolamine
phenyltoloxamine
prochlorperazine
promethazine
propoxyphene
pseudoephedrine
pyrilamine maleate
quazepam
secobarbital
temazepam
thiethylperazine
tramadol
triazolam
trimeprazine
tripelennamine
zaleplon
zolpidem
Analgesics – Pain Relief
NSAIDS:
All are acceptable. They do lead to increased risk of gastrointestinal bleeding or upset, renal disease and some classes may lead to increased risk of cardiovascular disease with prolonged use. This list includes drugs like Motrin, Aspirin, Celebrex and Toradol. Tylenol is also acceptable.

Safe Medications

OTC:    Advil, Aleve, Aspirin, Bufferin, Motrin, Tylenol

RX:    Bextra, Celebrex, Disalcid, Dolobid, Salflex, Toradol, Trisilate, Vioxx

MUSCLE RELAXERS:
Some are addicting and some are not. All opiate, narcotic type drugs are unacceptable. This even includes drugs like Ultram or Ultracet which can be addicting in and of themselves as well as lead you back to your primary drug of choice.

Safe Medications

RX:    Gablofen, Lioresal, Robaxin, Skelaxin, Zanaflex

Avoid These Pain Medications

RX:    Actiq, Avinza, Codeine, Darvon, Darvocet, Demerol, Dilaudid, Dolophine, Duragesic, Duramorph, Fentanyl, Flexeril, Kadian, Ketalar, Levo-Dromoran, Lorcet, Lortab, Mepergan Fortis, Methadone, Morphine Sulfate, MS Contin, Norco, Numorphan, Opana, Oramorph, Oxycontin, Paregoric, Percocet, Percodan, Roxanol, Roxicodone, Soma, Stadol, Ultracet, Ultram, Vicodin
Antibiotics – Drugs used to fight infections
None of these classes has been associated with relapses and have no addiction potential. All antibiotics do have risks associated with them. Some can cause insomnia, diarrhea, skin rashes and other even potentially life-threatening reactions. Remember, antibiotics do not kill viruses, only bacteria.
Acne Preparations
Some of the astringents have a high alcohol content so you need to be careful. Otherwise, this should not be a class of concern.
Allergy / Cold / Cough Medications

Safe drugs for allergies include Allegra, Claritin and Zyrtec. The ones without the decongestants (those without the -D) are preferred. Some of the over-the-counter drugs have addiction potential as well, so please check with your pharmacist or doctor before buying over-the-counter allergy, cough, or cold medications. Remember that chronic use of Afrin or similar agents leads to a physical addiction and you get rebound nasal congestion when you try and stop. For coughs we recommend Tessalon Perles, a cough suppressant, or Guaifenesin syrups or tablets as an expectorant. Cough drops or throat lozenges are also helpful.

Safe Medications – Allergy / Decongestants

OTC:    Allegra, Claritin, Hismanal, Tavist-1, Tripohist, Zymine, Zyrtec
Potential risk: Allegra D, Claritin D (contain pseudoephedrine)

Safe Medications – Cold / Cough Preparations

OTC:    Breonesis Capsule, Cepastat, Chloraseptic Sore Throat Spray, Mucinex Expectorant, Organidin NR, Robitussin Mucus + Chest Congestion, Zicam Cough Suppressant

Lozenges: Cepacol Sensations, Fisherman’s Friend, Hall’s, Luden’s, Ricola, all Sucrets except DM Cough Formula , Vicks VapoDrops

RX:    Duratuss G, Fenesin tablets, Humibid LA, Mycinette, Muco-Fen LA, Organidin NR, Tessalon Perles

Avoid these Medications

OTC:    Actifed, Alka-Seltzer, Benadryl only if it causes grogginess or drowsiness, Benylin Cough, Cepacol Sore Throat & Cough, Cepacol Sore Throat Spray, Cheracol Sore Throat Spray, Chloraseptic Sore Throat Max, Chlor-Trimeton, Comtrex, Contac, Coricidin, Delsym, Dimetapp, all Duratuss products except Duratuss G , Propagest, all Robitussin products except Mucus + Chest Congestion , Sudafed, Tylenol Cold products, Vicks products including Nyquil/Dayquil

Lozenges: Cepacol Sore Throat & Cough, Chloraseptic Total, Sucrets DM Cough Formula

RX:    Ah-Chew D, Ambenyl, Dimetane, Efidac, Endal HD, Hycodan, Hycomine, Novahistine DH, Nucofed, PBZ, Periactin, Phenergan (w/codeine), Polarmine, Propagest, Pyrilamine Maleate, Teldrin, Temaril, Tussionex
Asthma Medications
This class of drugs, including the inhalers, are historically safe although they can make you feel very nervous, jittery and can even cause increased heart rate and blood pressure.
Appetite Suppressants / Weight Loss

There are no safe diet pills in addiction that are rapidly effective. All of the stimulant classes of drugs to “speed up your metabolism” are potentially dangerous and may not be effective either. There are a couple of non-stimulant type drugs for weight control: Meridia and Xenical. Meridia works on serotonin and Xenical blocks fat absorption. Neither in our experience have been as successful as exercise and reduced portions of food.

Safe Medications

OTC:    Slim Fast, Slim Mint gum
RX:    Meridian, Xenical

Avoid these Medications

RX:    Acutrim, Adipex-P, Anorex, Bontril PDM, Control, Dexatrim, Didrex, Dieutrim, Fastin, Ionamin, Melfiat-105, Obephen, Pondimin, Prelu-2, Redux, Sanorex, Tenuate, Tepanil
Anxiety / Depression

The whole benzodiazepine class of drugs are potentially addicting. Those are medications like Xanax, Ativan, Valium, Klonopin, etc. There are safe alternatives to anxiety treatment such as Buspar, the SSRIs like Prozac, Paxil, Zoloft, Lexapro and Celexa, and other anti-depressants like Effexor or Cymbalta. Antidepressants as a general class are acceptable medications, BUT remember that early in recovery most people are depressed and just sobriety alone may be the only “drug” you need. Anxiety can be treated through other avenues besides drugs such as meditation and exercise.

Safe Medications

OTC:    For sleep issues, try Bevitamel (melatonin), chamomile tea, Sleepytime tea, or warm milk.
RX:    Butren, Buspar, Celexa, Cymbalta, Desyrel, Effexor, Lexapro, Paxil, Prozac, Vistaril, Wellbutrin, Zoloft

Avoid these Medications

OTC:    Benadryl, Compoz, Dormin, Excedrin PM, Legatrin PM, Nervine, Midol PM, Nightime Pamprin, Nytol, Sleep-eze, Sominex, Twilite, Tylenol PM, Unisom
RX:    Adapin, Alurate, Ambien, Amytal Sodium, Atarax, Ativan, Butisol Sodium, Chloral Hydrate, Dalmane, Dizac, Doral, Doriden, Elavil, Endep, Equanil, Gen-Xene, Halcion, Klonopin, Librax, Libritabs, Librium, Lunesta, Mebaral, Meprospan, Miltown, Nembutal Sodium, Paral, Paxipam, Placidyl, Prosom, Restoril, Seconal Sodium, Serax, Sinequan, Solfoton, Sonata, Trancopal, Tranxene, Tuinal Pulvules, Valium, Valrelease, Vanatrip, Xanax
Anti-Hypertensives (medicines to control blood pressure)
This broad class of drugs includes multiple different groups of medications, drugs like diuretics, ACE inhibitors, B-blockers, ARBS, calcium channel blockers and many more. As a general rule this broad class of drugs are safe in addiction.
Antilipemic Agents (medicines that lower cholesterol and triglyceride fats)
This class of drugs is not a problem in the addicted patient. Be aware that the statins like Lipitor, Crestor, etc. are metabolized by the liver and you need to have sequential liver monitoring, which requires frequent blood testing.
Antacid Medications
Any of the antacid products are safe to use. These include the over-the-counter formulas as well as prescription drugs like Nexium, Prevacid, Prilosec, Zantac, etc.
Central Nervous System Stimulants (medicines for ADD/ADHD)

This class of drugs is relatively CONTRAINDICATED in drug dependent patients. We prefer to use drugs that are non-stimulants to control these diseases, like Strattera or Wellbutrin. If one must have stimulants to control ADD/ADHD, it is safest to use the long-acting or slow release forms, but even these can lead to relapse.

Safe Medications

RX:    Intuniv, Strattera, Wellbutrin

Avoid these Medications

RX:    Adderall, Concerta, Daytrana, Desoxyn, Focalin, Ritalin, Vyvanse
Contraceptives
No contraindications in this class.
Erectile Dysfunction
This class of medication, drugs like Viagra, etc., is not contraindicated to use.
Hormones
Female hormones such as estrogen and progesterone are not addicting. Male hormones should ONLY be given for medical reasons. Anabolic or androgenic steroids are potentially addicting and dangerous.
Dental / Mouthcare Preparations

In dental procedures they can use local anesthesia to numb the mouth. It is best not to use Nitrous Oxide (laughing gas) or any relaxing agents before or during procedures UNLESS absolutely indicated. An NSAID, such as Toradol 10 mg, taken an hour before dental work will frequently keep pain under control. It is very important to let your dentist know that you have the disease of addiction, so that they do not give you prescriptions for narcotics.

Safe Medications

OTC:    Gly-Oxide
RX:    Orajel Perioseptic

Avoid these Medications

OTC:    Any mouth rinse containing alcohol, Peridex, Perioguard
RX:    Nitrous Oxide
Diabetes
Drugs used to treat this disease are not potentially addicting.
Gastrointestinal Medications

For diarrhea, Kaopectate and Imodium are acceptable. Lomotil is contraindicated. For stomach cramps, Bentyl or Levsin are safe. For nausea, Tigan and Vistaril are preferred. Phenergan is potentially dangerous.

Safe Medications

OTC:    Diasorb, Donnagel tabs, Emecheck, Emetrol, Imodium, Imodium AD caplets, Imodium Advance, Kaodene, Kaopectate, Kaopetolin, Lactinex, Nausetrol, Pepto-Bismol, Rheaban
RX:    Anzemet, Atarax, Bentyl, Emecheck, Emetrol, Kytril, Levsin, Maxolon, Nausetrol, Octamide, Reglan, Tigan, Vistaril, Zofran

Avoid these Medications

OTC:    Imodium AD Liquid, Pepto Diarrhea Control
RX:    Compazine, Donnagel Liquid, Logen, Lomotil, Lonox, Norzine, Paregoric, Phenergan, Thorazine, Torecan, Trilafon
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