Interaction between Alprazolam and Voriconazole
Major Metabolism

ID DDInter54 and DDInter1946
Interaction Coadministration with potent inhibitors of CYP450 3A4 including azole antifungal agents may significantly increase the plasma concentrations of benzodiazepines that are primarily metabolized by the isoenzyme.
Arrhythmia Candida Infection candidiasis of mouth cerebral infarct coma CMV infection diarrhea dizziness drowsiness empyema More
Management Although clotrimazole, fluconazole, miconazole, and voriconazole are weaker inhibitors of CYP450 3A4 than itraconazole and ketoconazole, product labelings for alprazolam and triazolam recommend against use with any azole antifungal agent. The same precaution probably applies also to oral midazolam and high dosages of intravenous midazolam. Terbinafine may be an appropriate alternative, as it is not an inhibitor of CYP450 3A4 and has been shown to have no effect on the pharmacokinetics of midazolam and triazolam. Alternatively, benzodiazepines that are not metabolized by CYP450 3A4 (e.g., lorazepam, oxazepam, temazepam) may be considered in patients requiring treatment with azole antifungal agents. Limited data suggest that fluconazole given intermittently (e.g., 150 mg once or once a week) may be safely administered in combination with midazolam and possibly other benzodiazepines.
References
Alternative for Alprazolam N05B
Oxazepam
Meprobamate
Alternative for Voriconazole J02A
Amphotericin B (cholesteryl sulfate)
Caspofungin
Amphotericin B (liposomal)
Miconazole (topical)
Anidulafungin
Flucytosine
Micafungin
Amphotericin B (lipid complex)

Potential Metabolism Interactions

Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.