Can a patient take naltrexone and Librium (chlordiazepoxide) together?

Naltrexone and Librium (Chlordiazepoxide) Combination

Yes, a patient can take naltrexone and Librium (chlordiazepoxide) together—there are no documented contraindications or significant drug interactions between these medications. However, this combination requires careful clinical consideration based on the specific indication for each medication.

Key Clinical Considerations

No Direct Contraindications

• Naltrexone-bupropion ER (Contrave) guidelines explicitly list contraindications, which include uncontrolled hypertension, seizure disorders, chronic opioid therapy, and use with MAO inhibitors—but benzodiazepines like chlordiazepoxide are not mentioned as contraindications 1.
• The FDA-approved safety profile for naltrexone-bupropion ER does not identify benzodiazepines as problematic co-medications 1.

Mechanism and Safety Profile

• Naltrexone is an opioid receptor antagonist with no abuse potential and mild, transient side effects 2.
• Chlordiazepoxide is a benzodiazepine that acts on GABA receptors—a completely different mechanism from naltrexone's opioid receptor antagonism 2.
• These medications work through distinct pharmacological pathways without overlapping mechanisms that would create dangerous interactions 3, 4.

Clinical Context Matters

For Alcohol Dependence:

• Both medications are used in alcohol dependence treatment, and naltrexone has been studied safely in patients with comorbid psychiatric conditions including depression 5.
• Chlordiazepoxide is commonly used for alcohol withdrawal management, while naltrexone reduces alcohol craving and relapse risk 3, 4.
• The combination may actually be clinically appropriate when managing acute alcohol withdrawal (chlordiazepoxide) followed by relapse prevention (naltrexone) 5, 3.

For Obesity Treatment (if using naltrexone-bupropion ER):

• The primary concern with naltrexone-bupropion ER is the bupropion component, which lowers seizure threshold—benzodiazepines may actually provide some protective effect against seizures 1.
• Monitor blood pressure and heart rate when using naltrexone-bupropion ER, especially in the first 12 weeks 1.

Important Caveats

Sedation and CNS Depression

• While not contraindicated, be aware that benzodiazepines cause CNS depression and sedation, which could theoretically be additive with any sedating effects from other medications.
• Monitor for excessive sedation, particularly during dose titration of either medication.

Psychiatric Monitoring

• Naltrexone-bupropion ER carries a black box warning for suicidal behavior/ideation in patients younger than 24 years with depression 1.
• Benzodiazepines can affect mood and cognition—monitor psychiatric symptoms closely when using both medications 1.

Specific to Naltrexone-Bupropion ER

• Contraindicated with chronic opioid therapy—naltrexone will precipitate withdrawal or block analgesic effects 1.
• Avoid in uncontrolled hypertension and seizure disorders 1.
• Reduce dose by half in moderate to severe renal impairment; limit to one tablet daily in moderate to severe hepatic impairment 1.

Practical Recommendations

The combination is safe to prescribe when:

• The patient requires both medications for legitimate clinical indications (e.g., alcohol withdrawal management transitioning to relapse prevention, or obesity treatment in a patient with anxiety requiring benzodiazepine therapy).
• The patient is not on chronic opioid therapy 1.
• Blood pressure is controlled if using naltrexone-bupropion ER 1.
• No active seizure disorder is present 1.

Monitor for:

• Excessive sedation or cognitive impairment from the benzodiazepine.
• Blood pressure and heart rate changes with naltrexone-bupropion ER 1.
• Emergence of psychiatric symptoms, particularly in younger patients 1.