What If… Patient Requires a Sedative?

• Benzodiazepines:

  • majority are substrates of CYP3A4
  • thus, a patient is at risk for prolonged/excessive sedation

• Reduce BZD dose and monitor

• Use BZD that are glucuronidated (lorazepam, oxazepam, temazepam)

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• The majority of benzodiazepines are substrates of CYP3A4, and hence are susceptible to interactions with CYP3A4 inhibitors.

• Significantly elevated benzodiazepine concentrations may result in prolonged or excessive sedative effects.

• Therefore, a reduced benzodiazepine dose should be used, with further dosage adjustments depending upon efficacy or toxicity.

• An alternative is to use a benzodiazepine which undergoes a different route of metabolism; oxazepam, lorazepam, and temezepam undergo glucuronidation, and may be less susceptible to inhibition interactions.