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Use for panic disorders with or without agoraphobia resistant to antidepressant therapy is an unlicensed indication. The MHRA reminds healthcare professionals that benzodiazepines and benzodiazepine-like drugs co-prescribed with opioids can produce additive CNS depressant effects, thereby increasing the risk of sedation, respiratory depression, coma, and death. Healthcare professionals are advised to only co-prescribe if there is no alternative and, if necessary, the lowest possible doses should be given for the shortest duration. Patients should be closely monitored for signs of respiratory depression at initiation of treatment and when there is any change in prescribing, such as dose adjustments or new interactions. If methadone is co-prescribed with a benzodiazepine or benzodiazepine-like drug, the respiratory depressant effect of methadone may be delayed; patients should be monitored for at least 2 weeks after initiation or changes in prescribing.
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