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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Medication For Anxiety While On Diflucan And Tetracycline For Lyme Disease

Looking for an anti-anxiety drug while I am on Diflucan and tetracycline for Lyme disease on my next two week pulse of therapy which does not cause QT prolongation and also does not metabolize via cytochrome p450. Diflucan interferes with Xanax which works now for me, and I cannot tolerate Ativan. Once I start on Diflucan, we will have problems with the Xanax.
Mon, 7 Feb 2022
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Internal Medicine Specialist,  's  Response
Hi,

Probably the best option here is going to be HYDROXYZINE. This is a good anti-anxiety medication and has a number of different doses (10mg is the lowest), it is metabolized through the CTY3A4 and 3A5 pathways without interference with the other meds. Now only at high doses >200 mg / 24 hours do we start to see any concern with QT prolongation and at the lower doses this is not an issue at all. With the BENZODIAZAPINES being not an option and anti-depressants not useful due to QT concerns, this med at lower doses is an option.

Another option is PROPRANOLOL, this is a beta blocker medication and is one also that actually should decrease the QT interval and not prolong it. So long as your blood pressure and pulse can tolerate the propranolol that might be a consideration. Be well.

Take care. Hope I have answered your question. Let me know if I can assist you further.

Regards,
Dr. David Girardi, Internal Medicine Specialist
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Suggest Medication For Anxiety While On Diflucan And Tetracycline For Lyme Disease

Hi, Probably the best option here is going to be HYDROXYZINE. This is a good anti-anxiety medication and has a number of different doses (10mg is the lowest), it is metabolized through the CTY3A4 and 3A5 pathways without interference with the other meds. Now only at high doses 200 mg / 24 hours do we start to see any concern with QT prolongation and at the lower doses this is not an issue at all. With the BENZODIAZAPINES being not an option and anti-depressants not useful due to QT concerns, this med at lower doses is an option. Another option is PROPRANOLOL, this is a beta blocker medication and is one also that actually should decrease the QT interval and not prolong it. So long as your blood pressure and pulse can tolerate the propranolol that might be a consideration. Be well. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. David Girardi, Internal Medicine Specialist