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Hydrocodone, Carisoprodol, and Alprazolam—A Most Lethal Combination

By now, just about everybody has heard plenty about all of the prescription opioid overdoses and deaths. Admittedly, all the anti-opioid, anti-MD, and anti-pain treatment propaganda being generated these days is a little overdone. In reality, about 3% of the US population, or about 10 million people, have been prescribed opioids in recent years. Compared with the overall number of people who have been helped, only a tiny percentage have overdosed. In addition, almost all of the overdoses have been persons who illegally obtained prescription opioids and/or failed to take them as prescribed. Nevertheless, opioid overdoses are something every prescriber must consider and attempt to prevent.

A recent article by Mathias B. Forrester is a most helpful report.1 He studied the drug ingestions reported to the Texas Poison Center between 1998 and 2009 and found that 1,295 cases overdosed on a single drug combination of three different drugs:

  • Hydrocodone (Vicodin, Lortab, Norco, Lorcet)
  • Carisoprodol (Soma)
  • Alprazolam (Xanax)

This is important and practical information. It points out that this specific combination may be the most dangerous of all opioid combinations. For example, every clinician knows the hazards of oversedation when benzodiazepines or carisoprodol is used with an opioid. But this survey suggests that alprazolam may be riskier than diazepam, lorazepam, or clonazepam. Carisoprodol is known to be a very abusable drug, especially when combined with an opioid. When used with alprazolam, it may be even more dangerous.

The message to practitioners and patients is simple. Just say no to this three-drug combo: alprazolam, carisoprodol, and hydrocodone. Stick to two of the three or vary the combination with a substitute drug.


Last updated on: February 11, 2016
First published on: November 1, 2011