Major
Alprazolam × Dronedarone
Benzodiazepines. Short-to-medium-acting anxiolytics×Class III antiarrhythmic
Mechanism
Dronedarone is a strong CYP3A4 inhibitor, the main alprazolam metabolic route. Alprazolam plasma levels may rise 2- to 4-fold. Deep sedation, fall risk in older patients.
Symptoms
Deep sedation, drowsiness, ataxia. Older patients: fall and fracture risk. Symptoms appear within 1–2 days.
Management
During dronedarone therapy, halve alprazolam or use lorazepam/oxazepam (glucuronidated, no CYP3A4 dependence).