Alprazolam drug interactions

Yuan R, Flockhart DA, Balian JD Pharmacokinetic and pharmacodynamic consequences of metabolism-based drug interactions with alprazolam, midazolam, and triazolam. J Clin Pharmacol 1999,39 1109-1125. 

For most child psychiatrists, the drug interactions most frequently encountered are interactions with other psychotropics. Fluoxetine inhibits the CYP3A isozymes and thus increase the plasma concentration of the tria-zolobenzodiazepines (alprazolam, midazolam, and triazolam), causing increased psychomotor effects (Shader and Greenblatt, 1995). To avoid unwanted psychomotor effects, the dosage of alprazolam should be decreased when it is coadministered with fluoxetine (Chouinard et ah, 1999). Nefazadone has also been shown to increase the pharmacodynamic effects of triazolam and, to a lesser extent, alprazolam (Chouinard et ah, 1999). 

FLUOXETINE, FLUVOXAMINE, PAROXETINE BZDs - ALPRAZOLAM, DIAZEPAM, MIDAZOLAM t in plasma concentrations of these BZDs. Likely t sedation and interference with psychomotor activity Alprazolam, diazepam and midazolam are subject to metabolism by CYP3A4. Fluvoxamine, fluoxetine and possibly paroxetine are inhibitors of CYP3A4 sertraline is a weak inhibitor. SSRIs are relatively weak compared with ketoconazole, which is possibly 100 times more potent as an inhibitor Warn patients about risks associated with activities that require alertness. Consider use of alternatives such as oxazepam, lorazepam and temazepam, which are metabolized by glucuronidation >- For signs and symptoms of CNS depression, see Clinical Features of Some Adverse Drug Interactions, Central nervous system depression... 

CICLOSPORIN BZDs-ALPRAZOLAM, MIDAZOLAM, DIAZEPAM Likely t plasma concentrations and risk of t sedation These BZDs are metabolized primarily by CYP3A4, which is moderately inhibited by cidosporin Warn patients about t sedation. Consider using alternative drugs, e.g. ffurazepam, quazepam. Warn about activities requiring attention For signs and symptoms of CN5 depression, see Qinkal Features of Some Adverse Drug Interactions, Central nervous system depression... 

Drug-drug interactions A small, randomised controlled trial (n = 20) with healthy volunteers found that psychomotor impairment of oxycodone with alprazolam was significantly greater than from either substance taken alone [66 ]. 

The dietary supplement kava has heen found to interact with alprazolam, a drug used to treat anxiety. 

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