Drug Interaction Report

MONITOR: Administration of fluvoxamine with certain benzodiazepines may increase CNS depression (e.g., sedation, ataxia). The mechanism appears to be inhibition of the CYP450 3A4 hepatic oxidative metabolism of the benzodiazepine. This interaction has been reported for alprazolam and diazepam, but may also occur with other benzodiazepines.

MANAGEMENT: The patient should be observed for increased CNS depression. Dosage adjustments may be required. Lorazepam, temazepam, and oxazepam, which are not metabolized by oxidative metabolism, may be better alternatives if a benzodiazepine is required.

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: 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.