Major Netupitant is a moderate inhibitor of CYP3A4 and should be used with caution in patients receiving concomitant medications that are primarily metabolized through CYP3A4, such as alprazolam. Send the page " " to a friend, relative, colleague or yourself. Relapse or return of illness was defined as a return of symptoms characteristic of panic disorder primarily panic attacks to levels approximately equal to those seen at baseline before active treatment was initiated. Gradually increase as needed and tolerated. Professionally-verified articles Daily or weekly updates Content custom-tailored to your needs Create an account. Less than 7 years: Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects.
Doctor prescribed: Alprazolam medication classifications list
|Alprazolam medication classifications list||478|
|Alprazolam medication classifications list||Alprazolam 0 5 mg tablets|
|Alprazolam medication classifications list||Xanax alprazolam is an anti-anxiety medication in alprazolam benzodiazepine family, the same family that medication diazepam Valiumclonazepam Klonopinlorazepam Ativanflurazepam Dalmaneand others. Darunavir list a potent CYP3A4 inhibitor. Alzheimer's and Classifications Brains. When prescribed by a doctor and used medication short periods of time, such as the day of surgery or classifications less than two weeks to aid sleep, benzodiazepines are alprazolam to take. The oral list of alprazolam given in a 0. Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as: If it is near the time of the next dose, skip themissed dose and resume your usual dosing schedule.|
|ALPRAZOLAM 0.25 MG PICTURES 900 SQ||850|
|ALPRAZOLAM 2MG FOR DOGS||103|
Swallow the tablet whole. It is specially made to release medicine slowly in the body. Breaking the tablet would cause too much of the drug to be released at one time. Do not share your medicine with other people. It may not be suitable for them and may harm them. If you miss a dose of Xanax, take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose.
Do not take extra medicine to make up the missed dose. Symptoms of a Xanax overdose include tiredness , confusion, impaired coordination, diminished reflexes, and coma. Death has been reported in association with overdoses of Xanax by itself, as it has with other benzodiazepines. If an overdose of Xanax occurs, call your doctor or Seek emergency medical attention or call the Poison Help line at Benzodiazepines, including Xanax, produce extra depressant effects on the central nervous system CNS when taken with:.
Studies of benzodiazepines other than Xanax suggest a possible drug interaction with the following drugs:. This list is not complete, and other drugs may interact with Xanax. Tell your doctor about all medications you use. This includes prescription, OTC, vitamin , and herbal products. It is important to taper off Xanax gradually; otherwise, there is a risk of benzodiazepine withdrawal syndrome. To discontinue treatment of Xanax, the dosage should be reduced and tapered slowly.
It is suggested that the daily dosage of Xanax be decreased by no more than 0. Reported withdrawal symptoms include:. Article last updated by Yvette Brazier on Thu 7 December All references are available in the References tab. Drug-related hospital emergency room visits. Drug and alcohol dependence, , Your privacy is important to us.
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Register take the tour. Reviewed by Alan Carter, PharmD. Table of contents What is Xanax? Fast facts on Xanax: Xanax alprazolam is the single most prescribed psychiatric medication in the U. Xanax is a member of the benzodiazepine family of drugs and is primarily used to treat anxiety and panic disorders. Xanax works by increasing the amount of the neurotransmitter GABA in the brain to promote calmness and a relaxed feeling. When taken correctly, Xanax is a safe and effective medication.
Xanax is used to treat severe anxiety or stress. Xanax and alcohol should not be mixed. Alcoholics should seek medical advice before taking Xanax. The benefits and risks of benzodiazepines. Benzodiazepines are a class of psychoactive drugs used to treat a range of conditions, including anxiety and insomnia. Possible side effects of Xanax include headaches, nausea, dizziness, blurred vision, and impaired memory.
Why is my eyebrow twitching? Eyebrow twitching may result from everyday factors, such as caffeine, or disorders such as hemifacial spasm. Learn about causes and when to see a doctor. In rare instances, death has occurred in patients with severe pulmonary disease shortly after the initiation of alprazolam.
Oral benzodiazepine used for the management of anxiety including panic disorder; relatively shorter half-life and absence of active metabolites; potential for significant CYP3A4 interactions. Use the lower dose for debilitated adults initially. If discontinuation becomes necessary, the manufacturer suggests that the daily dose be decreased by no more than 0. Some patients may require a more gradual and individualized taper. Lower initial doses may be appropriate in some patients.
If indicated, the dose may be increased gradually as tolerated. The elderly may be more sensitive to the effects of benzodiazepines. In addition, the facility should attempt periodic tapering of the medication or provide documentation of medical necessity in accordance with OBRA guidelines. Definitive dosage not established. Doses were increased in 0. Doses were titrated at 2-day intervals to a maximum of 0. Required doses ranged from 0.
In debilitated adults, a lower initial dose of 0. It is advisable to slowly titrate to higher doses and divide the doses throughout the waking hours on a 3 to 4 times per day schedule. Periodically reassess for possible dose reduction. If discontinuation becomes necessary, decrease the daily dose by no more than 0. The dose may be increased gradually as tolerated, at intervals of 3 to 4 days. The geriatric patient is more sensitive to the effects of benzodiazepines; use lowest effective dose.
Use the lower initial dose in debilitated adult patients. To switch from immediate-release alprazolam, calculate the total daily dose and administer once daily using the XR formulation. Gradually increase as needed and tolerated. However, the elderly are more sensitive to the effects of benzodiazepines; use the lowest effective dose. In a placebo-controlled, comparative study with oral progesterone of subjects, after 3 months, alprazolam was superior to progesterone or placebo overall but progesterone was better than alprazolam for physical symptoms while alprazolam was better than progesterone for controlling mood and mental function.
Alprazolam was initially dosed at 0. The actual alprazolam dose taken during the third treatment cycle was 1. Safety and efficacy have not been established; 0. Less than 7 years: Safety and efficacy have not been established. Quantitative guidelines are not available for the immediate-release product; consider initial dose reduction in those with hepatic impairment. A lower initial adult dose of extended-release alprazolam e.
Titrate as needed and tolerated to attain clinical goals. Guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed. Immediate-release tablets May be administered without regard to meals. With dry hands, place the tablet on top of the tongue where it will disintegrate and be swallowed with saliva. Administration with liquid is not necessary. Extended-release tablets Do not chew, break or crush.
Patient should swallow whole with a drink of water. Extended-release tablets should be taken preferably in the morning. Oral solution May be administered without regard to meals. Measure with a calibrated oral liquid medicine measuring device to give an accurate dose. Alprazolam is contraindicated in any patient with a known alprazolam or other benzodiazepine hypersensitivity or known allergies to any component of the formulation.
Alprazolam can cause physical and psychological dependence, and should be used with caution in patients with known, suspected, or a history of substance abuse. The risk of dependence with alprazolam appears to be most probable with daily dosages greater than 4 mg and with a treatment period of more than 12 weeks. Abrupt discontinuation of alprazolam after prolonged use should be avoided. Abrupt discontinuation of benzodiazepine therapy has been reported to cause a withdrawal syndrome see Adverse Effects , especially following high dose or prolonged benzodiazepine therapy.
However, benzodiazepine dependence can occur with therapeutic doses administered for as few as 1—2 weeks and withdrawal symptoms may be seen following the discontinuance of therapy. Benzodiazepine withdrawal also can be more intense if the benzodiazepine involved possesses a relatively short duration of action such as alprazolam. Panic rebound may be particularly problematic for patients receiving higher doses for panic disorder. Patients with a history of a seizure disorder or who are taking other drugs that lower the seizure threshold i.
During withdrawal, the greatest risk of seizure appears to be during the first 24 to 72 hours. Alprazolam immediate-release or extended-release formulations should be withdrawn slowly, using a gradual tapering schedule. Flumazenil, a benzodiazepine receptor antagonist, is indicated for partial or complete reversal of the depressive effects of benzodiazepines, and may be useful in overdose situations see Flumazenil monograph.
The prescriber should be aware of the risk for seizure activity with flumazenil use, particularly in long-term users of benzodiazepines or patients presenting with a cyclic antidepressant overdose. Worsening of daytime anxiety has been reported with the use of some hypnotic benzodiazepines, such as alprazolam, as few as 10 days after continuous use. In some patients this may be due to interdose withdrawal. If increased daytime anxiety is observed, it may be advisable to discontinue treatment gradually.
Although alprazolam is occasionally beneficial for patients with major depression, the drug should be administered to these patients with careful monitoring. According to the manufacturer, alprazolam typically has no use in the treatment of psychosis; use with extreme caution if at all in patients with suicidal ideation. Alprazolam should be used cautiously in patients with bipolar disorder because mania and hypomania have been reported in conjunction with the use of alprazolam in depressive disorders.
Due to CNS depression, patients should be cautioned against driving or operating machinery until they know how alprazolam may affect them. Some patients may experience excessive sedation and an impaired ability to perform tasks; although this is usually less than that seen with intermediate- or long-acting benzodiazepines. Increased CNS effects may be seen with concurrent use of alprazolam and other CNS depressant agents, and in patients with acute ethanol intoxication, or psychosis.
Patients with ethanol intoxication who have also consumed alprazolam have an increased risk of respiratory depression and coma. Ethanol should be avoided during treatment with alprazolam. Benzodiazepines should be used cautiously in patients in shock or coma due to the increased risk of respiratory depression. Anterograde amnesia may occur with any short-acting benzodiazepine if given in sufficient doses. Alprazolam is contraindicated in patients with acute closed-angle glaucoma.
However, the benzodiazepine may be used in patients with open-angle glaucoma who are receiving appropriate therapy. The mechanistic rational for this contraindication has been questioned, as benzodiazepines do not have antimuscarinic activity and do not raise intraocular pressure; few cases have been reported. Alprazolam should be used with extreme caution in patients with myasthenia gravis because the drug can exacerbate this condition.
Patients with late stage Parkinson's disease may experience worsening of their psychosis or impaired cognition with administration of benzodiazepines, such as alprazolam. Benzodiazepines may also cause incoordination or paradoxical reactions that may worsen symptoms of Parkinson's disease. The administration of alprazolam can exacerbate acute intermittent porphyria, so the drug should be used with caution in patients with this condition.
Alprazolam is classified as FDA pregnancy risk category D because it could harm the fetus when administered to pregnant women. Positive evidence of human fetal risk exists based on investigational, marketing, or human studies, but the potential benefit to the mother may outweigh the potential risks to the fetus.
In general, the use of benzodiazepines is not life-saving and thus should be avoided in pregnancy whenever possible. An increased risk of congenital malformations and other developmental abnormalities is associated with benzodiazepine use during the first trimester. If alprazolam is to be used during pregnancy or the patient becomes pregnant while taking alprazolam, the patient should be apprised of the potential hazard to the fetus.
The possibility that a woman of childbearing age may be pregnant when initiating therapy with alprazolam should be considered. Patients who become pregnant or intend to become pregnant while taking alprazolam should be advised to discuss the possibility of discontinuing the drug with their physician. It should be anticipated that neonates may experience withdrawal symptoms if the mother has been using benzodiazepines during pregnancy.
Neonatal flaccidity has been reported in an infant whose mother was using benzodiazepines during pregnancy. Alprazolam has no established use in labor or obstetric delivery. Many benzodiazepines distribute into breast milk. Because of the potential for adverse effects in the nursing infant, such as sedation, feeding difficulties, and weight loss, alprazolam generally is not recommended during breast-feeding.
The estimated dose that a breast-feeding infant would receive based on breat milk concentrations after single oral doses of 0. Irritability and withdrawal symptoms have been reported in babies exposed to alprazolam through breast milk upon discontinuation of either breast-feeing or alprazolam. Alprazolam is listed by the American Academy of Pediatrics as a drug whose effect on the nursing infant is not known but may be of concern, particularly with prolonged exposure.
If occasional maternal therapy with a benzodiazepine is required, a shorter-acting agent such as lorazepam may be considered. Some experts have concluded that occasional maternal treatment with usual doses of lorazepam would pose little risk to a nursing infant. If any benzodiazepine is used by a breast-feeding mother, monitor the infant for adverse effects, such as sedation. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition.
If a breast-feeding baby experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA. Alprazolam should be administered cautiously to patients with severe hepatic disease because the elimination half-life of the drug can be prolonged, possibly resulting in toxicity.
Patients with hepatic disease are more likely to experience adverse CNS reactions and should receive reduced initial dosages. Additionally, alprazolam is significantly metabolized via the hepatic microsomal P isoenzyme CYP3A4. Concomitant administration of alprazolam and potent inhibitors of CYP3A4 is contraindicated. Medications considered to be potent CYP3A4 inhibitors which should not be used concurrently with alprazolam include systemically-administered azole antifungals, some macrolide antibiotics, and anti-retroviral protease inhibitors see Drug Interactions.
This list is not inclusive of all agents that may potently inhibit CYP3A4. Reduced elimination of alprazolam has also been reported in obesity. Patients with renal impairment, including renal failure, should be carefully monitored during prolonged treatment with benzodiazepines, such as alprazolam, in order to avoid the adverse reactions that may occur from drug accumulation. The mean half-life of alprazolam is prolonged to Delayed elimination can either intensify or prolong the actions of adverse reactions of the drug.
It is recommended that the dosage be limited to the smallest effective dose to preclude the development of ataxia or oversedation which may be a particular problem in debilitated or geriatric patients. The impairment of cognitive and motor function may be more marked in this patient group and a lower dosage is recommended together with close monitoring. Benzodiazepines have been associated with falls in the elderly.
According to the Beers Criteria, benzodiazepines are considered potentially inappropriate medications PIMs for use in geriatric patients and avoidance is generally recommended, although some agents from this class may be appropriate for conditions such as rapid eye movement sleep disorders, severe generalized anxiety disorder, and end of life care. Older adults have an increased sensitivity to benzodiazepines. In general, all benzodiazepines increase the risk of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents in older adults.
The Panel recommends avoiding benzodiazepines in geriatric patients with the following disease states or symptoms due to the potential for exacerbation of the condition or increased risk of adverse effects: If a benzodiazepine must be used in a patient with a history of falls or fractures, consider reducing use of other CNS-active medications that increase the risk of falls and fractures and implement other strategies to reduce fall risk.
Specific criteria for anxiolytics must be met, including 1 limiting use to indications specified in the OBRA guidelines e. Anxiolytics should be used for delirium, dementia, or other cognitive disorders only when there are associated behaviors that are 1 quantitatively and objectively documented, and 2 are persistent, and 3 are not due to preventable or correctable reasons, and 4 constitute clinically significant distress or dysfunction to the LTCF resident or represent a danger to the resident or others.
There are exceptions that may warrant the use of an anxiolytic such as a long-acting benzodiazepine for withdrawal from a short-acting benzodiazepine, use for neuromuscular syndromes e. Benzodiazepines may increase the risk of confusion, sedation, and falls. OBRA provides dosing guidance for alprazolam as an anxiolytic. When a medication is being used to manage behavior, stabilize mood, or treat a psychiatric disorder, the facility should attempt periodic tapering of the medication or provide documentation of medical necessity in accordance with OBRA guidelines.
The safe and effective use of alprazolam in neonates, infants, children and adolescents less than 18 years old has not been established. Children are generally more sensitive to the CNS effects of benzodiazepines. Minor Patients taking benzodiazepines for insomnia should not use caffeine-containing products prior to going to bed as these products may antagonize the sedative effects of the benzodiazepine.
Additionally, the oral clearance of alprazolam 0. Alprazolam is a CYP3A4 substrate. Barbiturates are CYP3A4 inducers. Acetaminophen; Butalbital; Caffeine; Codeine: Major Concomitant use of opiate agonists with benzodiazepines may cause respiratory depression, hypotension, profound sedation, and death. Limit the use of opiate pain medications with benzodiazepines to only patients for whom alternative treatment options are inadequate.
If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect. If an opiate agonist is initiated in a patient taking a benzodiazepine, use a lower initial dose of the opiate and titrate to clinical response. If a benzodiazepine is prescribed for an indication other than epilepsy in a patient taking an opiate agonist, use a lower initial dose of the benzodiazepine and titrate to clinical response.
Educate patients about the risks and symptoms of respiratory depression and sedation. Avoid prescribing opiate cough medications in patients taking benzodiazepines. Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine: Moderate Coadministration can potentiate the CNS effects e. Use caution with this combination. Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide: Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate The therapeutic effect of phenylephrine may be decreased in patients receiving benzodiazepines.
Monitor patients for decreased pressor effect if these agents are administered concomitantly. Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine: Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: Moderate The CNS depressant effects of dichloralphenazone can be potentiated by benzodiazepines.
Avoid opiate cough medications in patients taking benzodiazepines. If oxycodone is initiated in a patient taking a benzodiazepine, reduce dosages and titrate to clinical response. For acetaminophen; oxycodone extended-release tablets, start with 1 tablet PO every 12 hours, and for other oxycodone products, use an initial dose of oxycodone at one-third to one-half the usual dosage. The dose of any opiate agonist administered with parenteral diazepam should be reduced by at least one-third.
Moderate Concomitant administration of alprazolam with CNS-depressant drugs, including anticonvulsants, can potentiate the CNS effects of either agent. Therefore, psychotropic pharmacodynamic interactions could occur following concomitant administration of drugs with significant CNS activity. Moderate Amoxapine may enhance the response to the effects of benzodiazepines and other CNS depressants. Patients should be warned of the possibility of drowsiness that may impair performance of potentially hazardous tasks such as driving an automobile or operating machinery.
There have been some case reports describing an interaction between omeprazole and benzodiazepines metabolized via the cytochrome P system, such as alprazolam. Patients should be monitored to determine if it is necessary to adjust the dosage of the benzodiazepine when taken concomitantly with omeprazole. Major Due to potent inhibition of alprazolam metabolism, it is recommended that alprazolam be avoided or reduced doses given when co-administered with anti-retroviral protease inhibitors.
Moderate Administration of nitrates such as amyl nitrite to patients receiving other hypotension-producing agents, such as benzodiazepines, can cause additive hypotensive or orthostatic effects. Moderate Monitor for withdrawal symptoms or lack of alprazolam efficacy if coadministration with apalutamide is necessary. Moderate Apomorphine causes significant somnolence.
Concomitant administration of apomorphine and CNS depressants could result in additive depressant effects. Minor No specific drug interactions were identified with systemic agents and apraclonidine during clinical trials. Theoretically, apraclonidine might potentiate the effects of CNS depressant drugs such as the anxiolytics, sedatives, and hypnotics, including barbiturates or benzodiazepines.
Major Use caution if alprazolam and aprepitant, fosaprepitant are used concurrently and monitor for an increase in alprazolam-related adverse effects for several days after administration of a multi-day aprepitant regimen. If a benzodiazepine is necessary, a dosage adjustment of the multi-day regimen may be necessary depending on the clinical situation e.
Consider selection of an agent that is not metabolized via CYP3A4 isoenzymes e. As a single mg or 40 mg oral dose, the inhibitory effect of aprepitant on CYP3A4 is weak, with the AUC of midazolam increased by 1. After administration, fosaprepitant is rapidly converted to aprepitant and shares many of the same drug interactions. However, as a single mg intravenous dose, fosaprepitant only weakly inhibits CYP3A4 for a duration of 2 days; there is no evidence of CYP3A4 induction.
Fosaprepitant mg IV as a single dose increased the AUC of midazolam given on days 1 and 4 by approximately 1. Less than a 2-fold increase in the midazolam AUC is not considered clinically important. Moderate Due to the primary CNS effects of aripiprazole, caution should be used when aripiprazole is given in combination with other centrally-acting medications including benzodiazepines and other anxiolytics, sedatives, and hypnotics.
The intensity of sedation and orthostatic hypotension is greater during concurrent use of lorazepam and oral aripiprazole and during use of a parenteral benzodiazepine and intramuscular IM aripiprazole compared to aripiprazole alone; therefore, patients receiving a benzodiazepine with oral or parenteral aripiprazole should be monitored for sedation and blood pressure and the dose should be adjusted accordingly.
Data from the manufacturer indicate there are no clinically significant pharmacokinetic changes when aripiprazole is given with lorazepam. Moderate Drugs that can cause CNS depression, if used concomitantly with asenapine, may increase both the frequency and the intensity of adverse effects such as drowsiness, sedation, and dizziness.
Caution should be used when asenapine is given in combination with other centrally-acting medications including anxiolytics, sedatives, and hypnotics including barbiturates , buprenorphine, buprenorphine; naloxone, butorphanol, dronabinol, THC, nabilone, nalbuphine, opiate agonists, pentazocine, acetaminophen; pentazocine, aspirin, ASA; pentazocine, and pentazocine; naloxone. Major Coadministration of alprazolam and atazanavir is not recommended.
If coadministration cannot be avoided, a dosage reduction of alprazolam should be considered. Atazanavir is a potent CYP3A4 inhibitor. The initial step in alprazolam metabolism is hydroxylation catalyzed by cytochrome CYP3A. Drugs that inhibit this metabolic pathway may profoundly decrease alprazolam clearance, resulting in increased potential for serious alprazolam-related adverse events, such as respiratory depression and prolonged sedation.
Consequently, alprazolam should be avoided in patients receiving very potent inhibitors of CYP3A isoenzymes. Moderate The plasma concentrations of alprazolam may be elevated when administered concurrently with cobicistat. Clinical monitoring for adverse effects, such as drowsiness or dizziness, is recommended during coadministration. Moderate Concurrent use of benzodiazepines and other CNS active medications including neuromuscular blockers, can potentiate the CNS effects of either agent.
Lower doses of one or both agents may be required. The severity of this interaction may be increased when additional CNS depressants are given. Atropine; Hyoscyamine; Phenobarbital; Scopolamine: Moderate Scopolamine may cause dizziness and drowsiness. Belladonna Alkaloids; Ergotamine; Phenobarbital: Moderate CNS depressants, such as anxiolytics, sedatives, and hypnotics, can increase the sedative effects of benztropine. Major Coadministration of alprazolam and boceprevir is not recommended.
Boceprevir is a potent CYP3A4 inhibitor. Moderate Bosentan is an inducer of cytochrome P enzymes, specifically the CYP2C9 and CYP3A4 isoenzymes, and may decrease concentrations of drugs metabolized by these enzymes, including alprazolam. Moderate Due to the CNS effects of brexpiprazole, caution should be used when brexpiprazole is given in combination with other centrally-acting medications including benzodiazepines and other anxiolytics, sedatives, and hypnotics.
Moderate Monitor for decreased efficacy of alprazolam if coadministration with brigatinib is necessary. Moderate Based on the sedative effects of brimonidine in individual patients, brimonidine administration has potential to enhance the CNS depressants effects of the anxiolytics, sedatives, and hypnotics including benzodiazepines. Moderate Drowsiness has been reported during administration of carbetapentane. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including benzodiazepines.
In patients treated with buprenorphine for opioid use disorder, cessation of benzodiazepines or other CNS depressants is preferred in most cases. Consider alternatives to benzodiazepines for conditions such as anxiety or insomnia in patients receiving buprenorphine maintenance treatment. Moderate It is common for patients to overlap anxiety treatment when switching from benzodiazepines to buspirone.
Buspirone has a slow onset of action and the drug will not block the withdrawal syndrome often seen with cessation of benzodiazepine therapy in those with benzodiazepine dependence. Therefore, before starting therapy with buspirone, withdraw patients gradually from the benzodiazepine. Alternatively, conversion to buspirone therapy may require treatment overlap to allow for the downward titration of the benzodiazepine while buspirone takes effect.
It should be noted that the combination of buspirone and benzodiazepines can potentiate the CNS effects e. Moderate Carbamazepine is a hepatic enzyme inducer and may potentially accelerate the hepatic metabolism of alprazolam leading to lower alprazolam serum concentrations. Concomitant administration of alprazolam with CNS-depressant drugs, including anticonvulsants, can potentiate the CNS effects e. Moderate Due to the CNS effects of cariprazine, caution should be used when cariprazine is given in combination with other centrally-acting medications including benzodiazepines and other anxiolytics, sedatives, and hypnotics.
Major Avoid coadministration of ceritinib with alprazolam due to increased alprazolam exposure. If coadministration is unavoidable, monitor for alprazolam-related adverse reactions including sedation and respiratory depression. Major Coadministration of alprazolam and chloramphenicol is not recommended. Chloramphenicol is a potent CYP3A4 inhibitor. Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: Moderate Coadministration of alprazolam should be avoided with potent CYP3A4 inhibitors such as cimetidine.
Moderate A decrease in the alprazolam dose may be needed. Ciprofloxacin is a CYP3A4 inhibitor and may reduce the metabolism of alprazolam and increase the potential for benzodiazepine toxicity. Moderate Cisapride may enhance the sedative effects of benzodiazepines. Patients should not drive or operate heavy machinery until they know how the combination affects them.
Patient counseling is important, as cisapride alone does not cause drowsiness or affect psychomotor function. Major Concomitant administration of clobazam with other CNS depressant drugs including anxiolytics, sedatives, and hypnotics, can potentiate the CNS effects i. In addition, concurrent use of clobazam and other benzodiazepines should generally be avoided since this may represent duplicative therapy, and centrally-mediated adverse effects may be potentiated.
Midazolam is a substrate of CYP3A4 and clobazam is a mild inducer of this isoenzyme. According to the manufacturer, dosage adjustments of CYP3A4 substrates are not considered necessary. Moderate If concurrent therapy with clozapine and a benzodiazepine is necessary, it is advisable to begin with the lowest possible benzodiazepine dose and closely monitor the patient, particularly at initiation of treatment and following dose increases. Although the combination has been used safely, adverse reactions such as confusion, ataxia, somnolence, delirium, collapse, cardiac arrest, respiratory arrest, and death have occurred rarely in patients receiving clozapine concurrently or following benzodiazepine therapy.
Several benzodiazepines, including clonazepam, oxazepam, flurazepam, diazepam, clobazam, flunitrazepam, and lorazepam have been implicated in these reactions. At least one case of sudden death was reported following intravenous administration of lorazepam to a patient receiving clozapine. Cobicistat; Elvitegravir; Emtricitabine; Tenofovir Alafenamide: Moderate Because promethazine causes pronounced sedation, an enhanced CNS depressant effect or additive drowsiness may occur when it is combined with other CNS depressants including benzodiazepines.
Major Coadministration of alprazolam and conivaptan is not recommended. Subsequent treatment with CYP3A substrates, such as alprazolam, may be initiated no sooner than 1 week after completion of conivaptan therapy. Conivaptan is a potent CYP3A4 inhibitor. Moderate Monitor for an increase in alprazolam-related adverse reactions including sedation and respiratory depression if coadministration with crizotinib is necessary; consider reducing the dose of alprazolam as clinically appropriate.
Drugs inhibiting this metabolic pathway may have a profound effect on the clearance of alprazolam. Coadministration with a strong CYP3A4 inhibitor increased plasma alprazolam concentrations by 3. Other drugs that may theoretically inhibit CYP3A4 metabolism of alprazolam include cyclosporine. Major Coadministration of alprazolam and dalfopristin; quinupristin is not recommended.
Dalfopristin; quinupristin is a potent CYP3A4 inhibitor. Major Coadministration of alprazolam and darunavir is not recommended. Darunavir is a potent CYP3A4 inhibitor. Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: Major Coadministration of alprazolam and ritonavir or lopinavir; ritonavir is not recommended. Lopinavir and ritonavir are potent CYP3A4 inhibitors. Severe According to the manufacturer of delavirdine, coadministration of alprazolam and delavirdine is contraindicated.
Delavirdine is a potent CYP3A4 inhibitor. Moderate Concurrent use with benzodiazepines can decrease the minimum alveolar concentration MAC of desflurane needed to produce anesthesia. Moderate Advise patients that concurrent use of deutetrabenazine and drugs that can cause CNS depression, such as alprazolam, may have additive effects and worsen drowsiness or sedation. Moderate Co-administration of dexmedetomidine with benzodiazepines is likely to lead to an enhancement of CNS depression.
Moderate Dicyclomine can cause drowsiness, so it should be used cautiously in patients receiving CNS depressants like benzodiazepines. Moderate Digoxin toxicity may occur in patients receiving alprazolam and digoxin. Patients receiving alprazolam or diazepam and digoxin concurrently should be monitored for increased serum digoxin levels. Moderate Consider a reduced dose of alprazolam is concurrent use of diltiazem is necessary.
Moderate Disulfiram can decrease the hepatic oxidative metabolism of alprazolam if administered concomitantly. Patients receiving alprazolam therapy should be monitored for signs of altered benzodiazepine response when disulfiram is initiated or discontinued. Moderate Use caution if the use of benzodiazepines are necessary with dronabinol, and monitor for additive dizziness, confusion, somnolence, and other CNS effects.
Alprazolam is a substrate for CYP3A4. The concomitant administration of dronedarone and CYP3A substrates may result in increased exposure of the substrate and should, therefore, be undertaken with caution. Major Droperidol administration is associated with an established risk for QT prolongation and torsades de pointes. In December , the FDA issued a black box warning regarding the use of droperidol and its association with QT prolongation and potential for cardiac arrhythmias based on post-marketing surveillance data.
Risk factors for the development of prolonged QT syndrome may include the use of benzodiazepines. Also, droperidol and benzodiazepines can both cause CNS depression. If used with a benzodiazepine, droperidol should be initiated at a low dose and adjusted upward, with caution, as needed to achieve the desired effect. Minor Oral contraceptives can increase the effects of alprazolam because oral contraceptives inhibit oxidative metabolism, thereby increasing serum concentrations of concomitantly administered benzodiazepines that undergo oxidation.
Patients receiving oral contraceptive therapy should be observed for evidence of increased response to alprazolam. Drospirenone; Ethinyl Estradiol; Levomefolate: Patients receiving benzodiazepines that are metabolized by these isoenzymes may experience decreased benzodiazepine serum concentrations if administered concurrently with efavirenz. Efavirenz should be used with caution with oxidized benzodiazepines including alprazolam.
Monitor patients closely for excessive side effects. Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate: Moderate Administering alprazolam with elbasvir; grazoprevir may result in elevated alprazolam plasma concentrations. If these drugs are used together, closely monitor for signs of adverse events. Moderate Concomitant administration can potentiate the CNS effects e. Major Monitor for withdrawal symptoms or lack of alprazolam efficacy if coadministration with enzalutamide is necessary.
Moderate Drugs that may inhibit CYP3A4, such as erythromycin, may inhibit the metabolism of alprazolam. Use alprazolam and erythromycin with caution and consider alprazolam dose reduction. Moderate Concomitant administration of alprazolam with CNS-depressant drugs, including anticonvulsants, can potentiate the CNS effects e. Additionally, eslicarbazepine is an inducer of the hepatic CYP3A4 isoenzyme thereby having the potential to lower the plasma levels of medications metabolized through these pathways.
The effectiveness of medications such as alprazolam could theoretically be decreased. Moderate Concomitant administration of benzodiazepines with eszopiclone can potentiate the CNS effects e. The concurrent use of eszopiclone with other anxiolytics, sedatives, and hypnotics at bedtime or in the middle of the night is not recommended. In addition, the risk of next-day psychomotor impairment is increased during co-administration of eszopiclone and other CNS depressants, which may decrease the ability to perform tasks requiring full mental alertness such as driving.
If used together, a reduction in the dose of one or both drugs may be needed. Major Alcohol is associated with CNS depression. The combined use of alcohol and CNS depressants can lead to additive CNS depression, which could be dangerous in tasks requiring mental alertness and fatal in overdose. Alcohol taken with other CNS depressants can lead to additive respiratory depression, hypotension, profound sedation, or coma.
Consider the patient's use of alcohol or illicit drugs when prescribing CNS depressant medications. In many cases, the patient should receive a lower dose of the CNS depressant initially if the patient is not likely to be compliant with avoiding alcohol. Ethinyl Estradiol; Ethynodiol Diacetate: Ethinyl Estradiol; Norethindrone Acetate: Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate: Ethinyl Estradiol; Norethindrone; Ferrous fumarate: Moderate Drugs that inhibit the CYP3A metabolic pathway, such as fluconazole, may profoundly decrease alprazolam clearance.
Because binding at the receptor is competitive and flumazenil has a much shorter duration of action than do most benzodiazepines, it is possible for the effects of flumazenil to dissipate sooner than the effects of the benzodiazepine. Flumazenil does not affect the pharmacokinetics of the benzodiazepines. Abrupt awakening can cause dysphoria, agitation, and possibly increased adverse effects. If administered to patients who have received a benzodiazepine chronically, abrupt interruption of benzodiazepine agonism by flumazenil can induce benzodiazepine withdrawal including seizures.
Flumazenil has minimal effects on benzodiazepine-induced respiratory depression; suitable ventilatory support should be available, especially in treating acute benzodiazepine overdose. Flumazenil does not reverse the actions of barbiturates, opiate agonists, or tricyclic antidepressants. Moderate Clinical study results suggest that the interaction between alprazolam, a CYP3A4 substrate fluoxetine, a CYP3A4 inhibitor may be of clinical significance, and caution is recommended during co-administration.
Monitor patients closely for excessive alprazolam-related side effects. Drugs that can cause CNS depression, if used concomitantly with olanzapine, can increase both the frequency and the intensity of adverse effects such as drowsiness, sedation, dizziness, and orthostatic hypotension.