PRACTITIONERS GUIDE FOR MEDICATIONS
IN ALCOHOL AND DRUG DEPENDENCE
 
INTRODUCTION
 
   It is likely the majority of chemically dependent persons will probably need medications (including both prescriptions and over-the counter) at some point in their recovery.  At any time, such medications should only be taken as prescribed by their primary physician in conjunction with their addiction specialist.
   This Guide is intended to serve as a resource for the recovering chemically dependent person and the medical professional prescribing treatment.  It is not meant to be used exclusively or as the sole means for providing advice regarding medications.  Indeed, this Guide would be best utilized in conjunction with other concurrent reference materials.
   Decisions about particular prescription medication(s) should be tailored to the needs of the individual patient under the direction of a health professional.  This Guide is not intended to be exhaustive, nor an endorsement of any particular brand name medication.  Rather it is intended to provide relevant pharmacological information to the recovering person and health care providers treating those in recovery.

GUARDING AGAINST ADDICTION
   Recovering alcoholics and addicts must be constantly alert to the possibility of triggering a relapse of their disease through the intake of drugs or alcohol.  Just as a diabetic needs to be cautious about the intake of sugar, the recovering alcoholic must be sensitive to drugs and the recovering addict must be sensitive to alcohol, and both must be sensitive to other mood-altering drugs, including prescribed and over-the-counter preparations.
   This Guide is designed to serve as a resource when making decisions regarding what medication(s) to take, as well as a reference tool for those who prescribe medication for persons in recovery.  The lists provided will serve as a resource when questioning the risk factors of the most commonly encountered drugs, including preparations containing alcohol.

USING THIS GUIDE
   Under strict medical guidelines, sometimes medications listed under "Potential Risk" may need to be dispensed.  Any such medications need to be firmly limited in both time and quantity, and administered under intensive rules including a signed contract with the patient.  Special caution must be exercised for over-the-counter drugs that are for sale in supermarkets, department stores, drug stores, discount stores, etc.  Individuals who do not realize cough syrups, tonics, vitamin preparations, and mouthwashes are sources of alcohol may be negatively affected.  Other substances that must be flagged include: antihistamines, cold preparations, and sinus medications.  Frequently these medications trigger the recurrence of cravings and the addictive process.  This Guide may be used to reference specific products and the associated risk factors.  Additionally, a safe listing is included.  Decisions about specific medications should be tailored to the needs of the individual by their treating physician and an addiction specialist.

THE DANGERS OF CROSS-ADDICTION
   An individual may think the use of addictive substances other than their drug of choice is permissible without risk of relapse.  In reality, any addictive drug or compound, including alcohol, will trigger specific receptor areas in the brain and eventually lead the addict back to active addiction either with their original drug of choice or a new drug of choice. 
   Recovering individuals frequently do not consider alcohol as a drug or prescriptions as being safe.  Just as patients with other serious medical conditions may not use certain foods/substances, the alcoholic and/or addict cannot use any addictive substance unless prescribed by a health professional knowledgeable in addiction medicine.  This Guide is critical for the identification of substances that should be carefully evaluated, as well as those that are acceptable.
   If you have any questions regarding the information contained in this Guide, please contact an addiction medicine specialist.
 
 
Medication Mood Altering Potential Safe Medication
Classification Ingredient to Avoid Risk List
Allergy /     Decongestants (Systemic) Brompheniramine Dimetane®, Dimetap® Travist-1® (Clemastine Fumarate)  Claritin® (Loratadine) Clarinex® (Desloratadine) Allegra® (Fexofenadine) Zyrtec® (Cetinzine)
Chlorpheniramine Chlor-Trimeton® Efidac®, Teldrin®
Dexchlorpheniramine Polaramine-RX®
Diphenhydramine Benadryl®              Benylin Cough®
Triprolidine Actifed®
Cyproheptadine Perictin-RX®
Phenylephrine AH-Chew D®, Entex LA® Nalex-A®, Prolex-D® Sinutuss DM®     Tussafed-EX® Potential Risk       

Allegra D®               Claritin D®                Zytrec D® (contains pseudoephedrine)
Promethazine Phenergan-RX®
Pseudoephedrine Sudafed®, Novafed, Profen
Anorexiants, Stimulants, and Weight Control Amphetamine Salts Adderall®, Dexedrine®  
Benzphetamine HCl Didrex® RX
Caffeine Red Dog®, Rip Tide®, Others Xenical® (Orlistat)
Diethylpropion HCl Tenuate®, Tepanilz®  
Ephedrine, Ephedra,    Ma Haung Metabolife®, Metobolite®  
Modafinil Provigil®  
Methylphenidate Concerta®, Metadate® Methylin®, Methylphenidate  
Nicotine Tobacco products Nicorette®, Nicoderm®  
Pemoline Cylert®  
Phendimetrazine Tartate Bontril PDM®, Anorex® Melfiat-105®, Prelu-2® Diet Ayds® (candy)    Slim-Mint® (gum)        Slim Fast®, Slender®
Phentermine HCl Fastin®, Adipex-P® Ionamin®, Obephen®
Medication Mood Altering Potential Safe Medication
Classification Ingredient to Avoid Risk List
Analgesics                (pain relief) Hydromorphone HCl Dilaudid® OTC
Levorphanol Tartate Levo-Dromoran® Advil®, Aleve®, Asprin®
Methadone HCl Dolophine® Bufferin®, Tylenol®
Meperidine HCl Demerol®         Mepergan Fortis® RX
Morphine Sulfate Avinza®, Duramorph® MS Contin®, MSIR® Roxanol® Disalcid®, Salflex® Dolobid®, Trilisate®
Opium Paregoric® Non-steroidal Anti-inflammatory Agents Anaprox®, Ansaid® Arthrotec®, Bextra® Cataflam®, Celebrex® Clinoril®, Daypro® Feldene®, Indocin® Lodine®, Meclomen® Mobic®, Motrin®  Nalfon®, Naprelan® Naprosyn®, Orudis® Oruvail®, Ponstel® Relafen®, Tolectin® Toradon®, Vioxx® Voltaten®
Alfentanil HCl Alfenta®
Fentanyl Sublimaze®   Duragesic®
Oxymorphone HCl Numorphan®
Propoxyphene Wygesic®, Darvon® Darvocet®
Sufentanil Citrate Sufenta®
Hydrocodone Bitartrate Anexsia®, Bancap® Hycodan®, Hydrocet® Lorcet®, Lorcet-HD® Lortab®, Maxidone® Norco®, Vicodin® Vicoprofen®, Zydone®
Methotrimeprazine Levoprome®
Malbuphine HCl Nubain®
Pentazocine Talwin NX®, Talacen®
Tramadol HCl Ultram®, Ultracet®
Carisoprodol Soma, Soma Compound with Codeine Dantrium®, Flexeril® Lioresal®, Robaxin® Skelaxin®
Levomethadyl ORLAAM®  
Buprenorphoine HCl Buprenex® Imitrex® (migraines) Zomig® (migraines)
Codeine Empirin #3,4®        Fiorcet w/ codeine® Fiorinal w/ codeine®
Analgesics with Barbiturates Esgic®, Fioricet®  Triad®, Phrenilin® Axocet®, Bucet® Fiorinal®, Axotal
Butorphanol Tartrate Stadol®
Caffeine Vanquish®, Excedrin® Goody's Powder®, Midol®, BC Powder® Cope®
Dihydrocodeine Bitrtrate DHC Plus® Caps   Panlor SS®        Synalgos-DC® Caps
Oxycodone HCl Oxcotin®, Oxyir® Percodan®, Percocet® Roxicet®, Tylox®
Medication Mood Altering Potential Safe Medication
Classification Ingredient to Avoid Risk List
Asthma Medication Ephedrine Primatene® Tablets RX
Epinephrine Primatene® Mist Advair®, Alupent® Brethine®, Combivent® Duoneb®, Maxair® Proventil, Pulimart® Qvar®, Vanceril® Volmax®
Cough / Cold (Preparation) Codeine Ambenyl®, Brontex® Hovahistine DH® Nucofed®,       Phenegran with Codeine Robitussin AC® OTC             (Guaifenesin)  Naldecon Senior EX® Organidin NR® Robitussin® Plain Breonesin® Capsule
Dextromethorphan Benylin®, Delsym® Dimetap Cough® Comtrex®, Contac® Duratuss® plain or DM Nyquil®           Novihistine DMX® Novafed® Profen® Robitussin DM®      Vicks Formula 44D®
Hydrocodone Compound Hycodan® Tabs & syrup Hycomine® RX        

(Guaifensin)       Organidin NR®     Duratuss G®         Fenesin Tablets® Humibid LA® (Benzonatate-sofgels) Tessolon Perles®
Hydrocodone Syrup (Multiple generics and trade names) Anaplex HD® Bitartrate/Guaifensin syrup, Duratuss HD® Hycotuss®     Hycotuss® Expectorant Hydrocodone Protuss/ProtussD Vicodan Tuss® Expectorant, Others
Diarrhea Alcohol Imodium A-D Liquid® Paregoric®, Pepto Diarrhea Control® Diasorb®          Donnagel® Tabs Kaopectate® Kaopetolin®, Kaodene® Lactinex®          Imodium® A-D capsules/tablets       Pepto-Bismol® Rheaban®
Diphenozylate HCL Atropine Sulfate Lomotil®, Logen® Lonox®
Tincture of Opium Donnagel Liquid®
Mouthwash / Mouthcare Dental Hygiene Alcohol Advance Formula N'Ice® Throat Spray, Cepacol® Cheracol Sore Throat Spray®, Listerine® Listermint®, Peridex® Perioguard®, Plax® Scope®           Sucretes® Spray Cepastar® Chloraseptic Gly-Oxide®             Halls® Lozenges Mycinette®                N'Ice® Lozenges     Orajel® Perioseptic  Sucrets® Lozenges Vicks® Cough Drops Vicks® Throat Discs
Medication Mood Altering Potential Safe Medication
Classification Ingredient to Avoid Risk List
Sedatives /      Antianxiety Agents Meprobamate Equanil®, Miltown® Meprospan® RX                

Adapine®, Buspar® (Buspirone HCL) Desyrel® (Trazadone) Elavil®, Mellaril®, Paxil® Seroquel®, Sinequan® Thorazine®, Trilafon®
Benxodiazepines: Benxodiazepines:
Alprazolam Xanaz®
Chlordiazepoxide Librium®, Libritabs® Librax®
Clonazepam Klonopin®
Clorazepate Tranxene®
Dipotassium Gen-Xene®
Diazepam Valium®, Valrelease® Dizax® OTC                     

Warm Milk
Etazolam ProSom®
Flurazepam Dalmane®
Halazepam Paxipam®
Lorazepam Ativan®
Oxazepam Serax®
Quazepam Doral®
Temazepam Restoril®
Tiazolam Halcion®
Non-Benzodiazepines: Non-Benzodiazepines:  
Chlormezanone Trancopal®  
Doxepin HCl Sinequan®, Adapin®  
Hydroxyzine HCl Vistaril/generic  
Hydroxyzine Pameate Atarax/generic  
Chloral Hydrate Chloral Hydrate  
Ethchlorvynol Placidyl®