Macrolides Alprazolam

MIDAZOLAM, TRIAZOLAM, POSSIBLY ALPRAZOLAM MACROLIDES -ERYTHROMYCIN, CLARITHROMYCIN, TELITHROMYCIN t BZD levels Inhibition of CYP3A4-mediated metabolism 1 dose of BZD by 50% warn patients not to perform skilled tasks such as driving for at least 10 hours after the dose of BZD... 

Thus, azole antifungal agents (such as ketoconazole and itraconazole), macrolide antibiotics, and protease inhibitors may also raise alprazolam plasma levels Inducers of CYP450 3A, such as carbamazepine, may increase clearance of alprazolam and lower alprazolam plasma levels and possibly reduce therapeutic effects... 

The serum levels and effects of midazolam, triazolam and zopi-clone are markedly increased and prolonged by erythromycin. The same interaction has been seen with clarithromycin, josamy-cin, or troleandomycin but not azithromycin. Alprazolam would be expected to be similarly affected. Other benzodiazepines, and the related hypnotic zaleplon, appear not to interact with the macrolides to a clinically significant extent... 

Limited information from single-dose studies suggests that erythromycin may increase levels of alprazolam and brotizolam but no pharmacodynamic changes were found. Nevertheless, the manufacturers advise caution if alprazolam is used with a macrolide. ... 

Carbamazepine levels are increased by CYP3A4 inhibitors (cimetidine, macrolides, diltiazem, fluoxetine, ketoconazole, verapamil, valproate) levels are decreased by CYP3A4 inducers (cisplatin, doxorubicin, felbamate, phenobarbital, phenytoin, primidone, rifampin, theophylline). Carbamazepine may increase levels of clomipramine, phenytoin, and primidone and lithium toxicity may decrease levels of phenytoin, warfarin, oral contraceptives, doxycycline, theophylline, haloperidol, alprazolam, clozapine, ethosuximide, and valproate may interfere with other anticonvulsants. 

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