Methadone/Propranolol/Trazodone Interactions?

[amuhree3]

I went to see a new therapist yesterday. I have been battling anxiety for 1/3 of my life. I am 33 and have also been going to a methadone treatment clinic for 10 years. I have been titrating for 2 years and currently on 17 mgs. Every doctor I have went to and told them about my treatment they suddenly look at me judgingly and don't want to help me. They give me crap that doesn't work, and makes my anxiety worse or makes me depressed and agitated. The only thing I have found so far to help my anxiety/panic attacks immediately is benzos.

I figured I would try out a social experiment on the therapist yesterday, and not revel to him I was on methadone. He prescribed me trazadone for sleep, propranolol for social anxiety and the physical effects of anxiety (fast heart rate, sweating, shaking), and 10 1mg pills of Ativan for break through panic attacks. I was not wanting a whole months script of benzos obviously because I am an addict but I really appreciated him thinking of the break through since most medication for anxiety doesn't start working for 3 weeks or longer.

My concern is since my doctor did not know I was on methadone and prescribed me these drugs, are any of them harmful while on methadone? I have done some research on my own and I found out Propranolol actually helps with opiate withdrawal so that actually may be a plus because since I am at such a low dose of Methadone now, I have been feeling the withdrawals but I do not want to stay on it any longer. I am mostly worried about the Trazadone, because I have read that interactions can be seizures, respiratory distress, coma, even death.

Please no lectures on lying to doctors, I know he will eventually find out and I am considering emailing him and confessing but I figured I would come here first. I have not taken anything but the Ativan yet since I have a high tolerance for benzos anyways.

Thank you for reading and appreciate any advice and help you can give

 

[Keif' Richards]

Hey @amuhree3 I received your note!

We definitely don't ever want to come across as anybody's internet parents, so I'm not going to lecture you too much. The basic bottom line is that, in the United States and I assume most other institutions of "Western Medicine" i.e. Europe and South America etc. have similar practices. Benzodiazepines are not meant to be taken for more than 2-4 weeks and thank god, they are all starting to see reason, as Benzodiazepines are insidiously destructive socially, psychologically and physically.

Even 10 years ago, when Benzodiazepines were arguably much more liberally prescribed, Methadone and Benzodiazepines were known as a widow-maker as far as drug combinations go. Generally, patients who are on MMT but still received Benzodiazepines are monitored closely, have medication checks and most importantly, have a specific reason beyond just anxiety as to why they should be taking Benzodiazepines. This is all pretty legitimate, as this combination is indeed a widow-maker. Before everybody started dropping from Fentanyl, it was much more common to be discussing people you know who died by means of Methadone + Benzo or Methadone+Alcohol or some combination of such.

Yes, you will be judged for being on Methadone. Most people in this world will judge you for being on Methadone. It's not necessarily fair, but often, that judgement is simply knowing that you're a drug addict and acting accordingly. It's not generally a malicious judgement, but as we all know, so docs try harder than others in putting themselves in our shoes. That, unfortunately is a game of chance in all of this. No doctor in this current climate will risk prescribing Benzodiazepines to a patient on Methadone for their own professional sake if for nothing else.

The drugs you're describing don't feature any serious contraindications with each other or with Methadone specifically. Propranolol lowers blood pressure, which would only come into play if you were taking higher dosages of Methadone. Trazodone shouldn't cause any problems either. It's an older antidepressant often mistakenly labeled an SSRI, it is actually an SARI or Serotonin Antagonist and Reuptake Inhibitor. Still, the function and end result are similar between these two classes of antidepressant, thus many of the side effects are shared between them, namely reduced libido.

Both Methadone and Trazodone have the potential to exacerbate heart rhythm problems. Both of these drugs have a tendency to provoke episodes of Low QT, which can be fatal. However, both your clinic prescriber and your psychiatrist should be aware of this possibility. When you tell him you are on Methadone, he will likely take you off the Trazodone immediately or otherwise plan for regular heart checkups. In the meantime, pay attention to what your heart is doing. Anything irregular like palpitations, faintness and etc should be checked out immediately at the hospital.