ModerateBenzodiazepines. Short-to-medium-acting anxiolytics×Calcineurin inhibitor (immunosuppressant)
Updated · Methodology
Mechanism
Tacrolimus is a weak CYP3A4 inhibitor; alprazolam is a CYP3A4 substrate. Alprazolam levels may rise moderately. Additive sedative effect.
Symptoms
Sedation, fatigue, slowed reactions, impaired coordination. In older patients: fall and fracture risk. Driving and operating machinery: accident risk.
Management
On starting the combination, begin alprazolam at 0.25 mg at bedtime. In transplant patients, prefer buspirone or CBT for anxiety over benzodiazepines. If unavoidable, tacrolimus monitoring is unchanged, but check sedation at 1 and 2 weeks after starting alprazolam.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Prograf (tacrolimus) prescribing information (2013)– ; DailyMed setid 7f667de1-9dfa-4bd6-8ba0-15ee2d78873b