Alprazolam with Roxithromycin Interaction Details
Brand Names Associated with Alprazolam
- Alprazolam
- Niravam®
- Xanax®
- Xanax® XR
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Feb 27, 2024
Interaction Effect
Increased benzodiazepine toxicity (CNS depression, ataxia, lethargy)
Interaction Summary
Macrolide antibiotics may inhibit hepatic enzymes responsible for benzodiazepine metabolism leading to increased plasma concentrations of benzodiazepines through reduced clearance, prolonged half-life, and increased volume of distribution[1][2][3][4].
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Observe patients receiving concurrent macrolide antibiotics and benzodiazepines for enhanced CNS effects. Warn patients regarding potential for drug hangover. Smaller benzodiazepine doses (dose reduction by 50% to 75%) may be required after two to four days of concurrent macrolide antibiotic dosing.
Mechanism Of Interaction
Decreased hepatic metabolism; decreased clearance
Literature Reports
A) An 8-year-old boy undergoing adenoidectomy was premedicated with oral midazolam 0.5 mg/kg and oral atropine 0.03 mg/kg, followed in one hour by intravenous erythromycin 400 mg. The patient lost consciousness 40 minutes later after 200 mg had been infused; other vital signs remained normal, and he regained consciousness after 45 minutes. At 170 minutes post-medication, his midazolam plasma concentration was 134 nanograms/mL (411 nanomol/L). Six other children who were similarly premedicated (midazolam 0.5 mg/kg and atropine 0.03 mg/kg) but did not receive erythromycin had a mean midazolam level of 73 nanograms/mL (224 nanomol/L) [4].
B) In a study involving normal volunteers, erythromycin (333 mg three times daily for three days) increased the peak levels of triazolam by 50%, increased the half-life from four to six hours, and decreased the volume of distribution [2].
C) A double-blind, placebo-controlled study of healthy volunteers has found that clearance of intravenously administered midazolam is reduced by about 50% following five days of erythromycin therapy versus placebo [3].
References
1 ) Warot D, Bergougnan L, Lamiable D, et al: Troleandomycin-triazolam interaction in healthy volunteers: pharmacokinetic and psychometric evaluation. Eur J Clin Pharmacol 1987; 32:389-393.
2 ) Phillips JP, Antal EJ, & Smith RB: A pharmacokinetic drug interaction between erythromycin and triazolam. J Clin Psychopharmacol 1986; 6:297-299.
3 ) Olkkola KT, Aranko K, Luurila H, et al: A potentially hazardous interaction between erythromycin and midazolam. Clin Pharmacol Ther 1993; 53:298-305.
4 ) Hiller A, Olkkola KT, Isohanni P, et al: Unconsciousness associated with midazolam and erythromycin. Br J Anaesth 1990; 65:826-828.
Alprazolam Overview
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Alprazolam is used to treat anxiety disorders and panic disorder (sudden, unexpected attacks of extreme fear and worry about these attacks). Alprazolam is in a class of medications called benzodiazepines. It works by decreasing abnormal excitement in the brain.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.