Lorazepam with Posaconazole Interaction Details
Brand Names Associated with Lorazepam
- Ativan®
- Lorazepam
- Lorazepam Intensol®
- Loreev XR®
Brand Names Associated with Posaconazole
- Noxafil PowderMix®
- Noxafil®
- Posaconazole
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 13, 2023
Interaction Effect
Decreased posaconazole serum concentration
Interaction Summary
The concomitant use of posaconazole and lorazepam appears to decrease posaconazole concentrations, especially with higher posaconazole doses (eg, 800 mg/day). Based on a small retrospective study (n=18), coadministration of posaconazole (primarily metabolized by uridine diphosphate glucuronosyltransferase (UGT)) with lorazepam (a possible inducer of UGT), resulted in significantly lower posaconazole levels compared with no concurrent benzodiazepine. Avoid coadministration of posaconazole with lorazepam. Temazepam may be a reasonable alternative to lorazepam during posaconazole therapy .
Severity
Moderate
Onset
Unspecified
Evidence
Established
How To Manage Interaction
Avoid concomitant use of posaconazole and lorazepam, especially in patients with low posaconazole levels. If appropriate, temazepam may be a reasonable alternative to lorazepam during posaconazole therapy.
Mechanism Of Interaction
Induction of uridine diphosphate glucuronosyltransferase (UGT)-mediated metabolism of posaconazole by lorazepam
Literature Reports
A) In a retrospective review of hospitalized adults receiving posaconazole, steady-state trough posaconazole concentrations were significantly reduced when coadministered with lorazepam. Routine therapeutic drug monitoring of posaconazole was preformed on 560 serum samples from 195 patients, including 31 samples from 18 patients taking concomitant lorazepam. Concurrent use of lorazepam was defined as any intake within 3 days before obtaining the posaconazole level. Mean posaconazole levels were lower with lorazepam coadministration (438 nanogram/mL (ng/mL) or 625 nanomol/L; median, 336 ng/mL or 479 nanomol/L) compared with no concurrent benzodiazepine (744 ng/mL or 1062 nanomol/L; median, 585 ng/mL or 835 nanomol/L). When posaconazole dose was evaluated, median posaconazole levels were significantly lower with concomitant lorazepam and posaconazole 800 mg/day (292 ng/mL or 417 nanomol/L) but not with posaconazole 600 mg/day (512 ng/mL or 731 nanomol/L) when compared with no concurrent benzodiazepine (585 ng/mL or 835 nanomol/L). Temazepam coadministration with posaconazole did not result in significantly lower posaconazole levels (53 samples in 27 patients). Investigators postulated that lorazepam induces posaconazole clearance by glucuronidation .
Lorazepam Overview
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Lorazepam is used to relieve anxiety. Lorazepam is also used to treat insomnia caused by anxiety or temporary situational stress. Lorazepam is in a class of medications called benzodiazepines. It works by slowing activity in the brain to allow for relaxation.
Posaconazole Overview
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Posaconazole is used to prevent serious fungal infections that can spread throughout the body in adults and children 2 years of age and older with a weakened ability to fight infection. Posaconazole delayed-release tablets are used to treat invasive aspergillosis (a serious fungal infection that begins in the lungs and spreads through the bloodstream to other organs) in adults and teenagers 13 years of age and older. Posaconazole oral suspension is also used to treat yeast infections of the mouth and throat including yeast infections in adults and teenagers 13 years of age and older that could not be treated successfully with other medications. Posaconazole is in a class of medications called azole antifungals. It works by slowing the growth of fungi that cause infection.
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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.