Interactions : אינטראקציות

4.5 Interaction with other medicinal products and other forms of interaction

The following drug interactions with oxazepam should be considered:

• Enhancement of other CNS depressant drugs such as barbiturates, antipsychotics, narcotic analgesics (enhancement of euphoria may also occur, leading to an increase in psychic dependence), antidepressants, hypnotics, anticonvulsants, anaesthetics, sedative antihistamines, lofexidine, nabilone and tizanidine.

• Opioids: The concomitant use of sedative medicines such as benzodiazepines or related drugs such as oxazepam with opioids increases the risk of sedation, respiratory depression, coma and death because of additive CNS depressant effect. The dosage and duration of concomitant use should be limited (see section 4.4).
• When taken with muscle relaxants, the overall muscle-relaxing effect may be increased (accumulative) therefore caution is advised, especially in elderly patients and at higher doses (risk of falling, see Section 4.4).
• Compounds which inhibit certain hepatic enzymes (particularly cytochrome P450) may enhance the activity of benzodiazepines. To a lesser degree this also applies to benzodiazepines which are metabolised only by conjugation.
• Oestrogen-containing contraceptives (concurrent use may cause a decrease in plasma levels of oxazepam).
• Antibacterials (Rifampicin may increase the metabolism of oxazepam).
• Antivirals (concurrent use of zidovudine with benzodiazepines may decrease zidovudine clearance. Ritonavir may inhibit benzodiazepine hepatic metabolism). The clinical significance of these interactions has yet to be established.
• Antiepileptic drugs (concurrent use of phenytoin may cause oxazepam serum levels to fall.
Side effects may be more evident with hydantoins or barbiturates).
• Alcohol (concomitant intake with alcohol is not recommended. The sedative effects may be enhanced when oxazepam is used in combination with alcohol. This affects the ability to drive or use machines).
• Antihypertensives (enhanced hypotensive effects. Enhances sedative effect with alpha blockers or moxonidine).
• Dopaminergics (concurrent use with benzodiazepines may decrease the therapeutic effects of levodopa).
• Baclofen (enhanced sedative effect).
• Probenecid (may increase effects and possibility of excessive sedation).