Drug Interactions between midazolam and Trecator-SC

GENERALLY AVOID: The concomitant use of protionamide with alcohol may enhance the central nervous system exciting effect of protionamide. The mechanism is not known. Excessive use of alcohol with another thiocarbamide derivative ethionamide, has been reported to precipitate a psychotic reaction. In addition, alcohol tolerance is reported to be reduced during protionamide treatment.

MANAGEMENT: Consumption of alcohol during protionamide treatment should be avoided. The manufacturer of ethionamide also advises that excess alcohol consumption should be avoided during ethionamide therapy (US).

GENERALLY AVOID: The pharmacologic activity of oral midazolam, triazolam, and alprazolam may be increased if taken after drinking grapefruit juice. The proposed mechanism is CYP450 3A4 enzyme inhibition. In addition, acute alcohol ingestion may potentiate CNS depression and other CNS effects of many benzodiazepines. Tolerance may develop with chronic ethanol use. The mechanism may be decreased clearance of the benzodiazepines because of CYP450 hepatic enzyme inhibition. Also, it has been suggested that the cognitive deficits induced by benzodiazepines may be increased in patients who chronically consume large amounts of alcohol.

MANAGEMENT: The manufacturer recommends that grapefruit juice should not be taken with oral midazolam. Patients taking triazolam or alprazolam should be monitored for excessive sedation. Alternatively, the patient could consume orange juice which does not interact with these drugs. Patients should be advised to avoid alcohol during benzodiazepine therapy.