Drug Interaction Report

MONITOR: Coadministration with teduglutide may increase the absorption of oral medications. The mechanism is attributed to teduglutide's action to improve intestinal absorption. A patient receiving prazepam started teduglutide 0.05 mg/kg once a day and within the first week experienced a dramatic deterioration in mental status progressing to coma. A prazepam blood concentration was found to be greater than 300 mcg/L; both drugs were discontinued, and the coma resolved 5 days later.

MANAGEMENT: Monitor patients receiving concomitant oral drugs requiring titration or with a narrow therapeutic index for adverse reactions due to potential increased absorption. The dose of the concomitant drug may need to be reduced.

MONITOR: Teduglutide has the potential to increase absorption of concomitantly administered oral medications. Altered mental status in association with teduglutide treatment has been observed in patients on benzodiazepines in clinical trials. In one case, a patient who received prazepam with teduglutide 0.05 mg/kg/day experienced dramatic deterioration in mental status progressing to coma during her first week of teduglutide therapy. She was admitted to the intensive care unit, where her benzodiazepine level was found to exceed 300 mcg/L. Both medications were discontinued, and the coma resolved five days later.

MANAGEMENT: Careful monitoring and possible dosage adjustment of oral medications that require titration or have a narrow therapeutic index are recommended during coadministration with teduglutide.

GENERALLY AVOID: Acute ethanol ingestion may potentiate the 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: Patients should be advised to avoid alcohol during benzodiazepine therapy.