One of the relapse pathways we struggle with in chemical and alcohol dependencies is exposing the mesolimbic system or the hypothalamus to drugs or chemicals that can lead to return to the primary drug of dependence. 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 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. To try and help you when you leave here, we have compiled a list of acceptable safe medications and have sought to include classes or individual drugs that we consider dangerous in the addicted patient. We have broken this down by diagnoses that are used in a primary care setting. It is in no way complete, meaning not every drug is listed. The FDA approved list of medications numbers in the thousands. So, 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 to seek over the counter medications.
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
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.
OTC: Advil, Aleve, Aspirin, Bufferin, Motrin, Tylenol
RX: Bextra, Celebrex, Disalcid, Dolobid, Salflex, Toradol, Trisilate, Vioxx
Some are addicting, and some are not. All opiate, narcotic type drugs are unacceptable. This 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.
RX: Gablofen, Lioresal, Robaxin, Skelaxin, Zanaflex Avoid These Pain Medications
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.
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.
Approved Medications – Allergy/Decongestants
OTC: Allegra, Claritin, Hismanal, Tavist-1, Tripohist, Zymine, Zyrtec Potential risk: Allegra-D, Claritin-D (contain pseudoephedrine)
Approved Medications – Cold / Cough Preparations
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
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.
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 is 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 antidepressants like Effexor or Cymbalta. Anti- depressants 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.
OTC: For sleep issues, try Bevitamel (melatonin), chamomile tea, Sleepytime tea, or
RX: Butren, Buspar, Celexa, Cymbalta, Desyrel, Effexor, Lexapro, Paxil, Prozac, Vistaril,
Avoid these Medications
OTC: Benadryl, Compoz, Dormin, Excedrin PM, Legatrin PM, Nervine, Midol PM, Nighttime 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 much more. As a general rule, this broad class of drugs is 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.
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.
RX: Intuniv, Strattera, Wellbutrin
Avoid these Medications
RX: Adderall, Concerta, Daytrana, Desoxyn, Focalin, Ritalin, Vyvanse
No contraindications in this class.
This class of medication, drugs like Viagra, etc., is not contraindicated to use.
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 / MOUTH CARE 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 indicated. A 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.
RX: Orajel Perioseptic
Avoid these Medications
OTC: Any mouth rinse containing alcohol, Peridex, Perioguard RX: Nitrous Oxide
Drugs used to treat this disease are not potentially addicting.
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.
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