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Published on: November 12, 2014
Pharmacokinetically induced benzodiazepine withdrawal
1Mood and Anxiety Disorders Program, Emory University School of Medicine in Atlanta, GA, USA. philninan@learnlink.emory.edu
Abstract:
Pharmacokinetic interactions between medications can have clinically significant effects. Concern usually arises when a medication is added to a continuing regimen, though discontinuation of a medication can also have an impact. A case is presented of a patient who experienced benzodiazepine withdrawal symptoms on discontinuation of nefazodone, an antidepressant that inhibits the cytochrome P450 3A4 isoenzyme. Plasma levels of alprazolam, a substrate for the 3A4 isozyme, fell rapidly when nefazodone was discontinued, presumably because of renewed 3A4 isoenzyme activity. The management of the patient's withdrawal symptoms is described.
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