Handbook of Drug Interactions

34 Moody
Table 16 (continued )
Dose Ethanol Ethanol
Benzodiazepine (mg) Dose Time N Reference
Flurazepam 30, or/d 14 d 0.5 g/kg 10 h 7f,33m 394
No effect on reaction time, reaction mistakes or attention;
enhanced effects on coordination skills.
Loprazolam 1, or 0.7 g/kg 0 h 8m 114
No effects on simple reaction time; alleviated lopraz-impairment
of manual dexterity; both alone impaired tracking, but not
together; memory impaired by lopraz, improved by EtOH,
not affected together.
Oxazepam 10, 20, or 40, or 0.5 g/kg 0 h 6m 391
Slightly enhanced the effects on coordination and mood.
Oxazepam 15, or 3/d 14 d 0.5 g/kg 0 h 20 115
No effect on reaction time, attention or propioception; enhanced
coordination mistakes at fixed and free speed.
Midazolam 0.1/kg, iv 0.7 g/kg 4 h 16m 395
Midazolam did not add to the +5h or +7h effects of EtOH.
Nitrazepam 10, or/d 14 d 0.5 g/kg 10 h 3f,17m 396
No effect on reaction times; enhanced choice reaction and
coordination mistakes and impaired attention.
Nordiazepam 5, or 3/d 14 d 0.5 g/kg 0 h 20 115
No effect on reaction time, attention or propioception; enhanced
coordination mistakes at fixed speed, no effect at free speed.
Prazepam 20, or 0.5 g/kg 0 h 12m 125
Enhanced impairment in auditory reaction and DSST; reduced
reaction to auditory stimuli and cancellation test and enhanced
drowsiness.
Temazepam 20, or 3/d 14 d 0.5 g/kg 0 h 20 115
No effect on reaction time or attention; enhanced coordination
mistakes at fixed speed, but not at free speed; enhanced
impairment of propioception.
Tofisopam 100, or 3 0.8 g/kg 12m 112
Enhanced impairment on coordination, reaction, flicker fusion,
maddox wing and attention tests.
Triazolam 0.25, or at 0.8–0.95 g/L 0.5–7.5 h 1f,6m 122
Enhanced impairment of free recall, postural stability, and
hand–eye coordination.
The timing of the administration of ethanol was an important factor. When ethanol
was given 3 h after alprazolam, only minimal effects were found (116). When ethanol
was given only 45 min after alprazolam, however, it had additive effects on most of the
end points measured (110). Similarly, combining ethanol with diazepam at the same
time led to enhanced impairment of reaction time (112), whereas giving the ethanol 3 h
after diazepam did not (116).
Ethanol, therefore, does appear to enhance the impairing effects of benzodiazepines
in an additive fashion. In the one study that measured driving skills, diazepam and
ethanol were taken together and the stimulated driving of professional drivers was