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Benzodiazepines

Benzodiazepines are central nervous system depressants used for anxiety, insomnia, and seizures. They carry serious interaction risks with opioids, alcohol, and other CNS depressants — combinations that can cause respiratory depression.

16 drugs in this class6 notable interactions shown

Benzodiazepines Drugs (16)

AlprazolamAlprazolam C-IvAlprazolam C-IvAlprazolam Odt C-IvAlprazolam Odt C-IvChlordiazepoxide And Amitriptyline HydrochlorideChlordiazepoxide And Amitriptyline HydrochlorideClobazamClobazamClonazepamDiazepamEstazolamLorazepamMidazolamMidazolam In 0.8% Sodium ChlorideMidazolam In 0.8% Sodium ChlorideMidazolam Injection, 10 MgN/AOxazepamQuazepamQuazepamTemazepamRestorilTriazolam

Notable Benzodiazepines Interactions

Alprazolam + ClarithromycinContraindicated

Strong CYP3A inhibitor is contraindicated with alprazolam due to profound effect on clearance, resulting in increased concentrations.

Alprazolam + FluoxetineContraindicated

Monoamine Oxidase Inhibitors (MAOIs): (2.9 , 2.10 , 4.1 , 5.2 ) Drugs Metabolized by CYP2D6: Fluoxetine is a potent inhibitor of CYP2D6 enzyme pathway (7.7) Tricyclic Antidepressants (TCAs): Monitor TCA levels during coadministration with fluoxetine or when fluoxetine has been recently discontinued (5.2 , 7.7) CNS Acting Drugs: Caution should be used when taken in combination with other centrally acting drugs (7.2) Benzodiazepines: Diazepam - increased t½, alprazolam – further psychomotor performance decrement due to increased levels (7.7) Antipsychotics: Potential for elevation of haloperidol and clozapine levels (7.7) Anticonvulsants: Potential for elevated phenytoin and carbamazepine levels and clinical anticonvulsant toxicity (7.7) Serotonergic Drugs: (2.9 , 2.10 , 4.1 , 5.2) Drugs that Interfere with Hemostasis (e.g., NSAIDs, Aspirin, Warfarin): May potentiate the risk of bleeding (7.4) Drugs Tightly Bound to Plasma Proteins: May cause a shift in plasma concentrations (7.6 , 7.7) Olanzapine: When used in combination with fluoxetine, also refer to the Drug Interactions section of the package insert for Symbyax (7.7) Drugs that Prolong the QT Interval: Do not use fluoxetine with thioridazine or pimozide. Coadministration of alprazolam and fluoxetine has resulted in increased alprazolam plasma concentrations and in further psychomotor performance decrement due to increased alprazolam levels.

Alprazolam + Fluoxetine HydrochlorideContraindicated

Monoamine Oxidase Inhibitors (MAOIs): (2.9 , 2.10 , 4.1 , 5.2 ) Drugs Metabolized by CYP2D6: Fluoxetine is a potent inhibitor of CYP2D6 enzyme pathway (7.7) Tricyclic Antidepressants (TCAs): Monitor TCA levels during coadministration with fluoxetine or when fluoxetine has been recently discontinued (5.2 , 7.7) CNS Acting Drugs: Caution should be used when taken in combination with other centrally acting drugs (7.2) Benzodiazepines: Diazepam - increased t½, alprazolam – further psychomotor performance decrement due to increased levels (7.7) Antipsychotics: Potential for elevation of haloperidol and clozapine levels (7.7) Anticonvulsants: Potential for elevated phenytoin and carbamazepine levels and clinical anticonvulsant toxicity (7.7) Serotonergic Drugs: (2.9 , 2.10 , 4.1 , 5.2) Drugs that Interfere with Hemostasis (e.g., NSAIDs, Aspirin, Warfarin): May potentiate the risk of bleeding (7.4) Drugs Tightly Bound to Plasma Proteins: May cause a shift in plasma concentrations (7.6 , 7.7) Olanzapine: When used in combination with fluoxetine, also refer to the Drug Interactions section of the package insert for Symbyax (7.7) Drugs that Prolong the QT Interval: Do not use fluoxetine with thioridazine or pimozide. Coadministration of alprazolam and fluoxetine has resulted in increased alprazolam plasma concentrations and in further psychomotor performance decrement due to increased alprazolam levels.

Alprazolam C-Iv + ClarithromycinContraindicated

Concomitant use with strong CYP3A inhibitor is contraindicated due to profound effect on alprazolam clearance resulting in increased concentrations.

Alprazolam C-Iv + ItraconazoleContraindicated

Concomitant use with strong CYP3A inhibitor is contraindicated due to profound effect on alprazolam clearance resulting in increased concentrations.

Alprazolam C-Iv + KetoconazoleContraindicated

Concomitant use with strong CYP3A inhibitor is contraindicated due to profound effect on alprazolam clearance resulting in increased concentrations.

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Data sourced from U.S. FDA drug labeling via openFDA and the NIH National Library of Medicine. For informational purposes only. Always consult your pharmacist or physician.