In concomitant use of psychotropic, anticonvulsant drugs and ethanol, an increase in the depressant effect of farmapram on the CNS is observed. Histamine H2-receptor blockers reduce the clearance of alprazolam and increase the CNS depressant effect of alprazolam; antibiotics from the group of macrolides reduce the clearance of alprazolam. Concomitant use of oral hormonal contraceptives increases the T1/2 of alprazolam.
When concomitant use of alprazolam with dextropropoxyphene, more pronounced CNS depression is observed than in combination with other benzodiazepines, because increased plasma concentrations of alprazolam may occur. Concomitant administration of digoxin increases the risk of cardiac glycoside intoxication. Alprazolam increases the plasma concentration of imipramine. When concomitant use, itraconazole, ketoconazole increase the effects of alprazolam. Concomitant use of paroxetine may increase the effects of alprazolam due to inhibition of its metabolism.
Fluvoxamine increases the plasma concentration of alprazolam and the risk of its side effects. Concomitant use of fluoxetine may increase the plasma concentration of alprazolam due to a decrease in its metabolism and clearance under the influence of fluoxetine, which is accompanied by psychomotor disorders. The possibility of enhancing the effects of alprazolam when used concomitantly with erythromycin cannot be excluded.
There is a mutual enhancement of the effect when concomitant administration of antipsychotic (neuroleptic), antiepileptic or hypnotic drugs, as well as central myorelaxants, narcotic analgesics, ethanol and drugs for general anesthesia. Inhibitors of microsomal oxidation of liver enzymes increase and inducers decrease plasma concentrations of alprazolam (alprazolam effectiveness may be altered). Alprazolam may increase the severity of BP reduction against the background of hypotensive drugs. Increased respiratory depression is possible when concomitantly prescribed with clozapine. Reduces the effectiveness of levodopa in patients with parkinsonism. May increase toxicity of zidovudine.
Hypersensitivity, coma, shock, myasthenia gravis, closed angle glaucoma (acute onset or predisposition), acute alcohol poisoning (with impairment of vital functions), narcotic analgesics, sleeping pills and psychoactive drugs; severe COPD (progressive degree of respiratory failure), acute respiratory failure; severe depression (suicidal tendencies may manifest); pregnancy (especially trimester I), lactation, age less than 18 years (safety and efficacy not determined). Caution. Liver failure, CKD, cerebral and spinal ataxia, drug addiction in anamnesis, predisposition to abuse of psychoactive drugs, hyperkinesis, organic brain diseases, psychosis (paradoxical reactions possible), hypoproteinemia, nocturnal apnea (established or suspected), elderly age. Fetal Action Category. D