Omeprazole with Clorazepate Interaction Details
Brand Names Associated with Omeprazole
- Omeprazole
- Prilosec®
- Prilosec® OTC
- Talicia (as a combination product containing Amoxicillin, Omeprazole, Rifabutin)
- Zegerid® (as a combination product containing Omeprazole, Sodium Bicarbonate)
- Zegerid® OTC (as a combination product containing Omeprazole, Sodium Bicarbonate)
Brand Names Associated with Clorazepate
- Clorazepate
- Gen-Xene®
- Tranxene®

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 05, 2023
Interaction Effect
An increased risk of clorazepate toxicity
Interaction Summary
Cytochrome isoenzymes CYP2C19 and CYP3A4 are responsible for the metabolism of omeprazole and clorazepate. Omeprazole has an inhibitory effect on the metabolism of clorazepate and its metabolite desmethyldiazepam that may prove clinically relevant. Short-term administration of omeprazole with dipotassium clorazepate can lead to a serious accumulation of clorazepate levels. Drugs of choice for stress ulcer prophylaxis for intensive care patients are those that are not metabolized by cytochrome P450 enzymes. Ranitidine, sucralfate, and pantoprazole are not expected to show any clinically significant interaction with drugs that affect the hepatic cytochrome P450 system.
Severity
Major
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Omeprazole has an inhibitory effect on the metabolism of clorazepate and its metabolite desmethyldiazepam that may prove clinically relevant. Short-term administration of omeprazole with dipotassium clorazepate can lead to a serious accumulation of clorazepate levels. Intensive care patients should be administered drugs for stress ulcer prophylaxis that do not significantly affect the hepatic cytochrome P450 system, such as ranitidine, sucralfate, or pantoprazole. None of these drugs are expected to show any clinically significant interaction with commonly prescribed medications in the intensive care unit. Potentially dangerous and unforeseeable adverse events may occur if this point is not observed.
Mechanism Of Interaction
Unknown
Literature Reports
A) A 60-year-old male with a history of essential hypertension, alcohol-induced fatty liver without hepatic cirrhosis, and chronic smoker's cough was admitted to a hospital for alcohol detoxification therapy. Treatment with intravenous dipotassium clorazepate was initiated on hospital day 5. The patient became unconscious within 29 hours and dipotassium clorazepate therapy was discontinued. The patient was administered a total of 1500 mg of dipotassium clorazepate, intravenous omeprazole 80 mg/day for stress ulcer prophylaxis, furosemide, thiamine, heparin, glucose, and electrolyte solutions. For several days the patient remained somnolent and comatose. Serum concentrations of the major active metabolite of dipotassium clorazepate, desmethyldiazepam, was 2100 mcg/L (therapeutic range 200-1000 mcg/L) seven days after dipotassium clorazepate was discontinued. The half-life of desmethyldiazepam can range from 30 to 200 hours. The half-life in this case is estimated to be approximately 550 hours. The patient showed signs of improvement thirteen days after dipotassium clorazepate therapy was discontinued. Clorazepate, like omeprazole, is metabolized via the cytochrome P450 2C19 and 3A4 isoenzymes. When these two drugs are administered concomitantly a serious accumulation of clorazepate levels can occur. In this case, the extended half-life of desmethyldiazepam is most likely due to an interaction between omeprazole and dipotassium clorazepate. The high dose of dipotassium clorazepate, however, in conjunction with reduced metabolic capacity from alcohol-induced liver damage may have contributed as well .
Omeprazole Overview
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Prescription omeprazole is used alone or with other medications to treat the symptoms of gastroesophageal reflux disease (GERD), a condition in which backward flow of acid from the stomach causes heartburn and possible injury of the esophagus (the tube between the throat and stomach) in adults and children 1 year of age and older. Prescription omeprazole is used to treat damage from GERD in adults and children 1 month of age and older. Prescription omeprazole is used to allow the esophagus to heal and prevent further damage to the esophagus in adults and children 1 year of age and older with GERD. Prescription omeprazole is also used to treat conditions in which the stomach produces too much acid such as Zollinger-Ellison syndrome in adults. Prescription omeprazole is also used to treat ulcers (sores in the lining of the stomach or intestine) and it is also used with other medications to treat and prevent the return of ulcers caused by a certain type of bacteria (H. pylori) in adults. Nonprescription (over-the-counter) omeprazole is used to treat frequent heartburn (heartburn that occurs at least 2 or more days a week) in adults. Omeprazole is in a class of medications called proton-pump inhibitors. It works by decreasing the amount of acid made in the stomach.
Clorazepate Overview
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Clorazepate is used to relieve anxiety. Clorazepate is also used along with other medications to treat certain types of seizures. It is also used to relieve unpleasant symptoms that may be experienced by people who have stopped drinking alcohol after drinking large amounts for a long time. Clorazepate is in a class of medications called benzodiazepines. It works by decreasing abnormal electrical activity 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.