Alprazolam interactions

The midazolam and possibly alprazolam interactions with carbamazepine appear to be of greatest clinical significance. Alprazolam and midazolam are both metabolised by the cytochrome P450 isoenzyme CYP3A4, of which carbamazepine is a known inducer. Much larger doses of midazolam are likely to be needed in the presence of carbamazepine. An alternative sedative may be needed. Triazolam is predicted to interact like midazolam. ... 

HassanPC, SprouleBA,HerrmannN,ReedK,NaianjoCA.Dose-respQnseevaluationofser-traline-alprazolam interaction in humans. CUnPharmacol 7 r(1998) 63,185. 

Almeida, J. C. Grimsley, E. W. (1996). Coma from the health food store interaction between kava and alprazolam. Ann. Intern. Med., 125, 940-1. 

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. 

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

Aprepitant (Emend) [Centrally Acting Antiemetic] Uses Pre-vents N/V assoc w/ emetogenic CA chemo (eg, cisplatin) (use in combo w/ other antiemetics) Action Substance P/neurokinin l(NKi) receptor antagonist Dose 125 mg PO day 1, 1 h before chemo, then 80 mg PO qAM days 2 3 Caution [B, /-] Contra Use w/ pimozide, Disp Caps SE Fatigue, asthenia, hiccups Interactions T Effects W/ clarithromycin, diltiazem, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, troleandomycin T effects OF alprazolam, astem-izole, cisapride, dexamethasone, methylprednisolone, midazolam, pimozide, terfe-nadine, triazolam, chemo agents, eg, docetaxel, etoposide, ifosfamide, imatinib, irinotecan, paclitaxel, vinblastine, vincristine, vinorelbine i effects W/ paroxetine,... 

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). 

Alprazolam did not exhibit any changes in pharmacokinetic parameters when administered concomitantly with GFJ (130) in a single dose experiment. When predosing existed, GFJ increased the exposure of alprazolam only in smokers. However, this interaction seems unlikely to be clinically relevant. In both parts of this study psychomotor fimction remained unchanged however, there was a small decrease in cognitive speed in the single dose part at one and two hours after dosing. Midazolam (6,15,133,134) and triazolam... 

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