Clarification on [D] Interactions

A member of DOCS Education asks:

I am showing some [D] interactions on Lexicomp for triazolam, diazepam, hydroxyzine and Ambien® as well as Norco®. We could skip the Ambien®, but I still have concerns about the Norco®. Any suggestions? This is a chronic pain patient.

Thanks

Dr. Anthony Feck, Dean of Faculty at DOCS Education, requested more information:

What are the medications that the patient is taking?

The [D] interaction with the Ambien® may only be the Intermezzo® form of Ambien®, and this may not apply to your patient.

The memeber responds:

Thanks for your reply. The patient is taking Norco®, Oxycontin®, Ambien®, Diovan®, Metformin, Bystolic® and Prozac®. I am showing [D] interactions with triazolam and Norco® as well as hydroxyzine and Norco®. I agree that the Ambien® is probably not a problem since it is not the Intermezzo® form, but I am confused about the Norco® interaction.

Dr. Feck gives this advice:

The [D] interaction rating between Norco® and other DOCS sedation medications is the result of the manufacturer of Norco® listing the severity of additive CNS depression in its product literature. Frankly, I would not have a problem sedating over top of Norco® or any hydrocodone product as long as the patient is monitored carefully and dosed with DOCS sedation meds appropriately.

This patient should not have diazepam the night before due to the number of CNS depressants they are taking. They will likely hyporespond on the day of the appointment.