Drug Interaction Report

MONITOR: Nefazodone, when administered with alprazolam or triazolam, has been reported to increase their half-life, area under the plasma concentration-time curve, and peak plasma concentrations. Increased sedation and altered psychomotor performance have resulted. The mechanism appears to be inhibition of the CYP450 3A4 enzyme by nefazodone. This interaction may occur with all benzodiazepines that undergo oxidative metabolism, although it has been reported only with alprazolam and triazolam.

MANAGEMENT: Patients receiving this combination should be monitored for excessive and prolonged sedation. It may be necessary to adjust benzodiazepine dosage when nefazodone is started or stopped. Lorazepam, oxazepam, and temazepam undergo conjugative metabolism and may be suitable alternatives.

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.

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.