Can benzodiazepines, opioids and muscle relaxants be combined in one patient?

The answer is No. This can be deadly. Never prescribe all three drugs to one patient. If a patient overdoses on opioids, the doctor who prescribed them can expect a review of records. Prescribing two of the three drugs is even more risky.

If the combination is truly medically necessary, then your rationale for prescribing them should be documented.

Never prescribe even one of these medications without performing and documenting a thorough assessment and diagnosing a condition that necessitates their prescription.

Always bear in mind that the patient may already be receiving an opioid from one provider or a benzodiazepine from another provider and/or a muscle relaxant from a third provider.

So, before prescribing any of these medications, tick off these questions from your checklist:

1.     Does my patient have a medical diagnosis that calls for this medication?

2.     Could the benefit be achieved with nonsteroidal drug, or through physical therapy or other nonpharmacologic treatment?

3.     Is there a risk of abuse in my patient?

4.     Have I done a urine drug screen?

5.     Do I have a written agreement with this patient about the goals of care and the conditions under which I will prescribe this medication?

6.     Am I prepared to follow-up and assess whether the medication is effective? Will I stop prescribing the medication and taper it off if the patient is not improving?

7.     Am I following opioid prescribing guidelines, and am I following them? 

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA