Benzodiazepines Alfentanil

Drugs that may affect fluconazole include cimetidine, hydrochlorothiazide, and rifampin. Drugs that may be affected by fluconazole include alfentanil, benzodiazepines, buspirone, carbamazepine, cisapride, oral contraceptives, corticosteroids, cyclosporine, haloperidol, HMG-CoA reductase inhibitors, losartan, nisoldipine, phenytoin, protease inhibitors, rifabutin, sirolimus, sulfonylureas, tacrolimus, theophylline, tolterodine, tricyclic antidepressants, vinca alkaloids, warfarin, zidovudine, and zolpidem. 

Opioids play an important role in anesthetic practice. Opioid analgesics potentiate the efficacy of anesthetics. They can be given as part of the premedication as well as during the operation. Examples of short acting agents with high potency are fentanyl, sufentanyl, alfentanil and remifentanil. Because of their hemodynamic stability these agents can be used for patients with compromised myocardial function. Respiration must be maintained artificially and may be depressed into the postoperative period. They are usually supplemented with inhalation anesthetic, benzodiazepines or propofol. 

Several drugs are used intravenously, alone or in combination with other drugs, to achieve an anesthetic state (as components of balanced anesthesia) or to sedate patients in intensive care units who must be mechanically ventilated. These drugs include the following (1) barbiturates (thiopental, methohexital) (2) benzodiazepines (midazolam, diazepam) (3) opioid analgesics (morphine, fentanyl, sufentanil, alfentanil, remifentanil) (4) propofol (5) ketamine and (6) miscellaneous drugs (droperidol, etomidate, dexmedetomidine). Figure 25-2 shows the structures of... 

Diltiazem caused a 43% mean increase in the half-life of midazolam in 30 patients who underwent coronary artery bypass grafting (57). Similar effects were observed with alfentanil. The proposed mechanism was diltiazem-induced inhibition of benzodiazepine metabolism by CYP3A. Patients taking diltiazem had delayed early postoperative recovery as a result. 

Benzodiazepines alprazolam, clonazepam, diazepam, midazolam, triazolam, zolpidem Calcium channel blockers diltiazem, nifedipine, nimodipine, verapamil Steroids androgens, estrogens, cortisol Others erythromycin, terfenadine, cyclosporine, dapsone, ketoconazole, lovastatin, lidocaine, alfentanil, amiodarone, astemizole, codeine, sildenafil... 

Clinically important, potentially hazardous interactions with alfentanil, aminophylline, amisulpride, amoxicillin, ampicillin, anticonvulsants, astemizole, atorvastatin, benzodiazepines, bromocriptine, buprenorphine, bupropion, carbamazepine, cilostazol, ciprofloxacin, cisapride, clindamycin, colchicine, cyclosporine, dasatinib, digoxin, dihydroergotamine, diltiazem, disopyramide, enoxacin, eplerenone, ergotamine, eszopiclone, everolimus, fluconazole, fluoxetine, fluvastatin, gatifloxacin, HMG-CoA reductase inhibitors, imatinib, itraconazole, ketoconazole, lomefloxacin, lorazepam, lovastatin, methadone, methylprednisolone, methysergide, midazolam, mizolastine, moxifloxacin, nitrazepam, norfloxacin, ofloxacin, paroxetine, pimozide, pravastatin, quinolones, ranolazine, repaglinide, rupatadine, sertraline, sildenafil, simvastatin, sparfloxacin, sulpiride, tacrolimus, terfenadine, triazolam, troleandomycin, vardenafil, verapamil, vinblastine, warfarin, zaleplon, zolpidem, zuclopenthixol... 

Combining midazolam and alfentanil or fentanyl for the induction of anaesthesia reduces the dose required of both the benzodiazepine and the opioid, when compared with either drug alone.The interaction is synergistic. ... 

Inereased sedative and respiratory depressant effeets are to be expeeted when benzodiazepines are used with opioids. The manufaeturers of sufentanil and alfentanil suggest that elinieally important hypotension may oeeur and this may be exaeerbated by the use of benzodiazepines it would seem prudent to be alert for this. The manufaeturers of transdermal fentanyl also warn of the possibility of respiratory depression, hypotension, profound sedation and potentially coma with concurrent CNS depressants including benzodiazepines. When such combined therapy is contemplated, the dose of one or both drugs should be significantly reduced. ... 

Opioid analgesic drugs (OADs), particularly fentanyl and its analogs alfentanil, remifentanil, and sufentanil, are extensively used for anesthesia and analgesia. Administration of intravenous hypnotics and OADs as a high dose opioid, low dose hypnotic (usually a benzodiazepine such as midazolam) has found wide application in cardiac anesthesia and to produce procedural sedation for endoscopy, catheterizations, and a variety of other surgical procedures where sedation and... 

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