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Cimetidine Injection and Xanax

Determining the interaction of Cimetidine Injection and Xanax and the possibility of their joint administration.

Check result:

Cimetidine Injection <> Xanax

Relevance: 21.09.2023 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Using ALPRAZolam together with cimetidine may increase or prolong the effects of ALPRAZolam. Contact your doctor if you experience dizziness, drowsiness, confusion, and difficulty concentrating. If your doctor does prescribe these medications together, you may need a dose adjustment to safely use both medications. Also, avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR: Administration of cimetidine with benzodiazepines may increase systemic exposure to benzodiazepines. The mechanism may be related to inhibition of CYP450 3A4 hepatic metabolism by cimetidine, a moderate inhibitor of this isoenzyme. This interaction has been reported for alprazolam, diazepam, triazolam, midazolam and chlordiazepoxide, but may also occur with other benzodiazepines. In one pharmacokinetic study, two groups of healthy subjects (n=8) were administered cimetidine (1 g daily) for 2 weeks, with the addition of either alprazolam (0.5 mg three times a day) or triazolam (0.5 mg nightly) during the second week of cimetidine administration. Concomitant administration with cimetidine led to statistically significant alterations in some of the pharmacokinetic parameters of the benzodiazepines. Alprazolam systemic exposure, (AUC [0 to infinity]) and Cmax increased by 73% and 82%, respectively, and clearance (L/h) decreased by 42%. Triazolam systemic exposure (AUC [0 to infinity]) and Cmax increased by 120% and 51%, respectively, half-life increased by 68%, and clearance (L/h) decreased by 55%. This interaction appears to be minimal with lorazepam, oxazepam, and temazepam. Ranitidine may increase or decrease benzodiazepine plasma levels; however, the effects are not expected to be clinically significant. This interaction has not been noted with other H2 antagonists.

MANAGEMENT: The US manufacturers of alprazolam, estazolam and triazolam recommend consideration of a dose reduction when these medicines are co-administered with cimetidine. The authors of the abovementioned pharmacokinetic study suggest either a reduction to the alprazolam dose by one-third or an increase to the dosage interval to twice daily when used concomitantly with cimetidine. Use of H2 antagonists and benzodiazepines that are not reported to interact may also be considered. Patients should be advised to avoid hazardous activities requiring 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.

References

Klotz U, Reimann I "Influence of cimetidine on the pharmacokinetics of desmethyldiazepam and oxazepam." Eur J Clin Pharmacol 18 (1980): 517-20
Salonen M, Aantaa E, Aaltonen L, Kanto J "Importance of the interaction of midazolam and cimetidine." Acta Pharmacol Toxicol (Copenh) 58 (1986): 91-5
Gough PA, Curry SH, Araujo OE, Robinson JD, Dallman JJ "Influence of cimetidine on oral diazepam elimination with measurement of subsequent cognitive change." Br J Clin Pharmacol 14 (1982): 739-42
Pourbaix S, Desager JP, Hulhoven R, Smith RB, Harvengt C "Pharmacokinetic consequences of long term coadministration of cimetidine and triazolobenzodiazepines, alprazolam and triazolam, in healthy subjects." Int J Clin Pharmacol Ther Toxicol 23 (1985): 447-51
Wrighton SA, Ring BJ "Inhibition of human CYP3A catalyzed 1'-hydroxy midazolam formation by ketoconazole, nifedipine, erythromycin, cimetidine, and nizatidine." Pharm Res 11 (1994): 921-4
Sanders LD, Whitehead C, Gildersleve CD, Rosen M, Robinson JO "Interaction of H2-receptor antagonists and benzodiazepine sedation. A double-blind placebo-controlled investigation of the effects of cimetidine and ranitidine on recovery after intravenous midazolam." Anaesthesia 48 (1993): 286-92
Klotz U, Reimann I "Delayed clearance of diazepam due to cimetidine." N Engl J Med 302 (1980): 1012-4
Britton ML, Waller ES "Central nervous system toxicity associated with concurrent use of triazolam and cimetidine." Drug Intell Clin Pharm 19 (1985): 666-8
Andersson T, Andren K, Cederberg C, Edvardsson G, Heggelund A, Lundborg P "Effect of omeprazole and cimetidine on plasma diazepam levels." Eur J Clin Pharmacol 39 (1990): 51-4
Greenblatt DJ, Abernethy DR, Morse DS, Harmatz JS, Shader RI "Clinical importance of the interaction of diazepam and cimetidine." N Engl J Med 310 (1984): 1639-43
Parker WA, MacLachlan RA "Prolonged hypnotic response to triazolam-cimetidine combination in an elderly patient." Drug Intell Clin Pharm 18 (1984): 980-1
Greenblatt DJ, Locniskar A, Scavone JM, Blyden GT, Ochs HR, Harmatz JS, Shader RI "Absence of interaction of cimetidine and ranitidine with intravenous and oral midazolam." Anesth Analg 65 (1986): 176-80
Abernethy DR, Greenblatt DJ, Divoll M, Moschitto LJ, Harmatz JS, Shader RI "Interaction of cimetidine with the triazolobenzodiazepines alprazolam and triazolam." Psychopharmacology (Berl) 80 (1983): 275-8
Klotz U, Arvela P, Rosenkranz B "Effect of single doses of cimetidine and ranitidine on the steady-state plasma levels of midazolam." Clin Pharmacol Ther 38 (1985): 652-5
Desmond PV, Patwardhan RV, Schenker S, Speeg KV "Cimetidine impairs elimination of chlordiazepoxide ( librium) in man." Ann Intern Med 93 (1980): 266-8
Patwardhan RV, Johnson RF, Sinclair AP, Schenker S, Speeg KV "Lack of tolerance and rapid recovery of cimetidine-inhibited chlordiazepoxide (librium) elimination." Gastroenterology 81 (1981): 547-51
Ruffalo RL, Thompson JF, Segal J "Cimetidine-benzodiazepine drug interaction." Am J Hosp Pharm 38 (1981): 1365-6
Wilson CM, Robinson FP, Thompson EM, Dundee JW, Elliott P "Effect of pretreatment with ranitidine on the hypnotic action of single doses of midazolam, temazepam and zopiclone. A clinical study." Br J Anaesth 58 (1986): 483-6
Klotz U, Reimann IW, Ohnhaus EE "Effect of ranitidine on the steady state pharmacokinetics of diazepam." Eur J Clin Pharmacol 24 (1983): 357-60

Cimetidine Injection

Generic Name: cimetidine

Brand name: Tagamet HB, Tagamet

Synonyms: Cimetidine

What is Cimetidine Injection?

Xanax

Generic Name: alprazolam

Brand name: Niravam, Xanax, Xanax XR, Alprazolam Intensol

Synonyms: n.a.

What is Xanax?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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