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PostPosted: Tue Sep 08, 2009 1:54 pm 
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Does anyone know if Suboxone is counter-indicated with Benedryl or Levabuterol (brand name Xopenex). I am on vacation and a few days ago had to be taken to the ER in the middle of the night with a severe allergic reaction to something (we are not sure what precipitated it.) I was having extreme difficulty breathing and was told I was having an asthmatic reaction. I've never had asthma before, but had been suffering from a pretty bad bout with Bronchitis for a few weeks prior to this incident. Not surprisingly (unfortunately) not ONE of the nurses in the ER knew what Suboxone even was. When I told them I was on it, they were clueless.

I was given a breathing treatment with a nebulizer and the medication Xopenex (levalbuterol.) Because of a cardiac condition I have (a conduction problem called Wolfe-Parkinson-White syndrome) they used the levabuterol instead of straight albuterol. The treatment worked and I was released with a rescue inhaler. I was reading some of the counter-indications for other meds and one that was listed was Methadone. I know that Sub and Methadone are two totally different drugs, but I'm wondering if there is any problem with this medication and Suboxone.

Also, being that this is evidently an allergic reaction to something, and given the nature of allergies, it stood to reason to me that if I could "knock" the allergen down by taking some doses of Benedryl, my breathing may improve. I did read somewhere that, because of the CNS and respiratory effects, that Benedryl and Suboxone should be used together with caution.

Does anyone know if this is, in fact, true? I am desperate to get this breathing thing under control. I'm claustrophobic to begin with, and this is killing me!!

Thanks for any help, advice or experience with this anyone out there can offer!!


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PostPosted: Tue Sep 08, 2009 1:56 pm 
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I think you might need to talk to a pharmacist. I've taken benadryl while on Suboxone, but with your unique set of circumstances I'd seek professional advice on this one.

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PostPosted: Tue Sep 08, 2009 8:19 pm 
Hey Rose - sorry for your troubles! I am not a doctor, but have 18 years experience as an RN in a critical care area, so some familiarity with meds, etc. Also have an allergic, asthmatic daughter! Allergies are a strange, hard to figure out phenomenon! Unfortunately, we often never are able to determine what exactly the offending agent that caused the reaction is. You just get into this vicious cycle of reactions, especially worrisome when the respiratory system is involved.
Sounds like you got decent care even though the ER had no clue about Suboxone.
I know from experience that Benedryl is (when used as directed) one of the more benign medications out there. So I would only assume that there is no problem with using it with Suboxone. As far as the Xopenex - I know we preferred it over Albuterol for breathing treatments for our more complex patients. It seems to have less pronounced side effects, especially in terms of the tachycardia (rapid heart beat) that almost always goes along with the Albuterol type meds. Almost all asthma meds carry that side effect - rapid pulse, shakiness, anxiety - just classic side effects of that family of medications. Almost, if not all, rescue inhalers have a tendency to do that. I imagine that's why they chose Xopenex for you with your history of WPW syndrome. They were trying to avoid throwing you into a dangerous heart rhythm. I wonder, did they give you a Xopenex rescue inhaler or something else?
I can see the concern with Benadryl and Methadone - the docs and drug companies always have to caution strongly regarding combining two drugs with a side effect of sedation and respiratory depression. I'm not sure, but I don't think Subxone has near the potential as full agonists for that respiratory depression effect. As with everything else - when used as directed the risk of advers effects like that drops dramatically.
Anyway, as I said, we used Xopenex for our high-risk patients with no untoward effects, so I bet it's okay with Suboxone. I can't imagine it causing a problem.
I agree with Diary though - always best to check with the doctor or a pharmacist - hopefully you'll get a straight answer!
Sometimes with allergies and bronchitis it just takes a while for everything to get healed and working right again. Try not to worry too much. Perhaps a daily antihistamine would be in order until things get better. Zyrtec seems to work pretty well for most allergies and has a low side effect profile. I'd probably choose it over daily dosing with benadryl as it tends to cause so much more drowsiness than Zyrtec. It's available over the counter now.
Again, I am not a doctor, certainly no expert, but that's my 2 cents worth!

Hope you're feeling better soon!


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PostPosted: Wed Sep 09, 2009 12:04 am 
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Thank you both so much for the feedback. I mentioned in an earlier post that I have been under the care of a "joke" of a clinic for my Suboxone maintenance program. I called today to speak with the nurse about taking xopenex with suboxone and she refused to ask the doctor for me. She said that the Dr. that prescried the openex should be the one to ask. I explained that the Dr. that prescribed it was an ER Dr., that it was 4:00 a.m. when I saw him and I was pretty out of it. I also told her that it was a little alarming to me that NO ONE in the ER knew what Sub even was. I further told her that Dr. P (don't want to say his name here) had been my Dr. for the last 1.5 years as opposed to a Dr. I saw once in the ER who was trying to fix one specific problem. Still, she refused to ask the Dr. for me. Unbelievable.

I did call the Suboxone information line. I found out that the xopenex is not a problem. The benedryl only so far as the depressed respirations. But what I did find out is that prednisone, which I was put on at a high dose, and Cipro, which was started by my Sub Dr. are both agents that cause the Sub to act stronger in your system. She explained that it has something to do with the enzymes. I've heard so much different medical jargon today that it is hard to keep it straight.
I'm actually in the hospital now. My breathing got so much worse that I had to return for a breathing treatment and the ER Dr. admitted me. I am having my second treatment while I'm writing this with no bad effects. Also decided to cut my Sub by 1/3 while on prednisone. Anyone know anything about that?

Again, thank you both so much for taking time to respond!


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