Drug Interaction Report

MONITOR: Benzodiazepines may counteract the beneficial effects of acetazolamide in preventing altitude sickness by inhibiting respiratory responses to hypoxia. The medical team that accompanied the China-Japan-Nepal Friendship Expedition to Mount Everest in 1988 reports severe hypoventilation in some climbers when acetazolamide and triazolam were given together. One affected climber could be ordered to breath regularly, but repeatedly 'forgot' to continue breathing. This syndrome has been referred to as 'Ondine's curse'.

MANAGEMENT: Caution is recommended if a CAI and a benzodiazepine must be used together. Until more information is available, it may be prudent to avoid the concurrent use of triazolam and acetazolamide at extreme altitudes.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.