20-004 Be Aware of Opioid Potentiator Medications

Date: 01/15/20

Be Aware of Opioid Potentiator Medications

California Health & Wellness Plan (CHWP) wants to help you and your patients prevent opioid medication misuse. When used in conjunction with opioids, some medications enhance the opiate effect. CHWP encourages providers to be aware of such potentiator medications, including those listed in the table below.

Although this is not a comprehensive list, it is important to consider these medication classes when prescribing in order to best protect the health and safety of patients and combat misuse. Providers should consider the interaction of an opioid and a potentiator to determine the risks and benefits associated with their combination.

Opioid potentiators

Drug class		Medication	Significant considerations
Central nervous system (CNS) depressants
Benzodiazepines (BZDs)	alprazolam, clonazepam, diazepam, lorazepam		Both opioids and BZDs sedate users, suppress breathing and impair cognitive function
Antihistamines	promethazine		Increased risk for respiratory depression, coma and death when used with opioids *The combination of carisoprodol, BZDs and opioids results in a heroin-like high
Antipsychotics	quetiapine
Barbiturates	phenobarbital
BZD-like hypnotics	zolpidem, zaleplon, eszopiclone
Gabapentinoids	gabapentin, pregabalin
Muscle relaxants	tizanidine, cyclobenzaprine, baclofen, carisoprodol*
Pharmacokinetic enhancers
Antibiotics	clarithromycin		CYP450 inhibition leads to increase in serum opioid concentration Ultimately results in strong CNS depression
Antifungals	itraconazole, ketoconazole, posaconazole
HIV drugs	ritonavir, atazanavir, indinavir, cobicistat
Other potentiators
Stimulants	dextroamphetamine, methylphenidate		Extremely high abuse potential Used in combination to combat fatigue and sedation caused by high daily doses of opioids or to increase the analgesic effect

The chart above was adapted from information provided by the Centers for Medicare & Medicaid Services (CMS).