Mutual enhancement of the effect is noted in case of simultaneous administration of antipsychotic (neuroleptic), antiepileptic or hypnotic drugs, as well as central muscle relaxants, narcotic analgesics, ethanol and drugs for general anesthesia. Inhibitors of microsomal oxidation of liver enzymes increase, and inducers decrease the plasma concentration of farmapram (alprazolam effectiveness may be changed).
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.
Concomitant use of psychotropic, anticonvulsants and ethanol may increase the CNS depressant effect of alprazolam.
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.
Simultaneous use of itraconazole and ketoconazole increases 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.
For endogenous depression, alprazolam may be used in combination with antidepressants. When using alprazolam in patients with depression, cases of hypomanic and manic states have been noted.
Alprazolam should be used with caution in patients with hepatic and/or renal dysfunction.
In patients who have not previously taken CNS-affecting drugs, alprazolam is effective at lower doses compared to patients who have received antidepressants, anxiolytics or suffer from chronic alcoholism.
With long-term use in high doses, the development of addiction and the formation of drug dependence is possible, especially in patients prone to drug abuse.