Alprazolam has possible interactions with alcohol, some other drugs, and certain supplements. Examples include medications for sleep and pain medications. Talk with your doctor to avoid potentially harmful effects from alprazolam interactions.Alprazolam is a generic drug prescribed for generalized anxiety disorder and panic disorder in adults. Alprazolam is available as the brand-name drug Xanax.An interaction occurs when one substance causes another substance to have a different effect than expected.Alprazolam comes in different forms, and they have similar interactions. The forms are:immediate-release (IR) oral tablets (alprazolam IR tablets)orally disintegrating tabletsoral liquid solutionextended-release (ER) oral tabletsIR tablets release the drug into your body all at once. ER tablets release the drug into your body slowly, over a longer period of time. This article will focus on interactions for alprazolam IR tablets. You can talk with your doctor to learn more about other forms.By learning about possible alprazolam interactions, you can work with your doctor to ensure alprazolam will be safe and effective for you to take. For additional information about alprazolam, including details about its uses, see this alprazolam overview article. »Learn more about alprazolam IR tablet, including details about its uses.Alprazolam interactions with other drugsBefore you start treatment with alprazolam, tell your doctor and pharmacist about any prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. To learn whether alprazolam interacts with supplements, herbs, or vitamins, see the 'Alprazolam and other interactions' section.If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.Here's a table of drugs that can interact with alprazolam. Keep in mind this table doesn't include all drugs that may interact with alprazolam. Some of these interactions are described in detail in 'Drug interactions in depth.'Drug class or drug nameDrug examplesInteraction result with alprazolamdigoxin (Lanoxin)—can increase the risk of side effects of digoxinritonavir (Norvir)—can increase the risk of side effects of alprazolamopioids• buprenorphine (Sublocade, others)• codeine• fentanyl (Fentora, others)• hydrocodone (Hysingla ER)• morphine (MS Contin)• oxycodone (Roxicodone, others) • tramadolcan increase the risk of side effects of alprazolam and opioids other central nervous system (CNS) depressants• zolpidem (Ambien, Ambien CR)• cyclobenzaprine (Amrix)• amitriptyline• risperidone (Risperdal)• diphenhydramine (Benadryl)can increase the risk of side effects of alprazolam and other CNS depressantsCYP3A inhibitors (see 'When to avoid alprazolam' for details)• cimetidine (Tagamet HB) • clarithromycin• erythromycin• fluvoxamine• itraconazole (Sporanox)• ketoconazole• amlodipine (Norvasc)can increase the risk of side effects of alprazolam CYP3A inducers• carbamazepine• phenytoincan make alprazolam less effectiveWhen to avoid alprazolamIn some cases, factors or conditions could prevent your doctor from prescribing alprazolam due to the risk of harm. These are known as contraindications. The following are the contraindications of alprazolam.Note: Before you start treatment with alprazolam, it's important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe alprazolam.Taking medications that are strong CYP3A inhibitorsDoctors typically will not prescribe alprazolam in combination with drugs that are strong inhibitors of cytochrome P450 3A (CYP3A), an enzyme in your body that helps break down alprazolam. Drugs that are strong CYP3A inhibitors block or slow the action of this enzyme.Taking alprazolam with a strong CYP3A inhibitor can cause too much alprazolam to build up in your body. This interaction can raise your risk of developing serious alprazolam side effects, such as severe drowsiness or difficulty breathing.The following drugs are examples of strong CYP3A inhibitors:clarithromycinitraconazole (Sporanox)ketoconazolenelfinavir (Viracept)posaconazole (Noxafil)voriconazole (Vfend)Before you start treatment with alprazolam, it's important to tell your doctor about any medications you take, including any of those listed. They can check whetehr it's safe to take alprazolam with your other medications.Note that taking ritonavir, an antiviral drug, is not an alprazolam contraindication, even though it's considered a strong CYP3A inhibitor. In some cases, your doctor may prescribe alprazolam with ritonavir. However, they may prescribe a lower dosage of alprazolam than usual, monitor you closely for side effects, or both.Having had an allergic reaction to alprazolam or any of its ingredientsIf you have had an allergic reaction to other benzodiazepines or alprazolam or any of its ingredients, your doctor will likely not prescribe alprazolam. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.Alprazolam interaction with alcohol Your doctor will likely recommend that you do not drink alcohol while taking alprazolam. They'll also usually advise you not to take any prescription or over-the-counter drugs that contain alcohol during alprazolam treatment.Consuming alcohol and taking alprazolam may cause serious side effects, including:difficulty breathingsleepinessdecreased awarenessThe combination of alcohol and alprazolam may also, in some cases, lead to coma or even death. If you have concerns about avoiding alcohol while you're taking alprazolam, talk with your doctor before starting treatment.Drug interactions in depthHere's a closer look at certain drug interactions of alprazolam.CNS depressantsSome drugs can speed up the activity of your central nervous system (CNS), which includes your brain and spinal cord.Other drugs can slow the activity of your CNS. Slow CNS activity can result in sleepiness and slowed breathing, among other effects. Drugs and substances that can slow the CNS are called CNS depressants, or sometimes 'sedatives.' As with other benzodiazepine drugs, alprazolam is a CNS depressant.Taking alprazolam with other CNS depressants can increase the risk of certain side effects from alprazolam and CNS depressants. These side effects may include extreme drowsiness, dizziness, difficulty breathing, and decreased responsiveness.Here are some examples of CNS depressants that may interact with alprazolam:sleeping pills, such as eszopiclone (Lunesta) and zolpidem (Ambien, Ambien CR)muscle relaxers, such as cyclobenzaprine (Amrix) and carisoprodol (Soma)tricyclic antidepressants, such as amitriptyline and trazodoneantipsychotics, such as risperidone (Risperdal) and haloperidol (Haldol)certain antihistamines, such as diphenhydramine (Benadryl) and hydroxyzine (Vistaril)opioids, such as codeine (see the following 'Note')alcoholNote: Alprazolam has a boxed warning about the risk of dangerous effects if taken with opioids. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more about this interaction, see the boxed warnings section near the top of this article.Steps you or your doctor may takeIf your doctor prescribes alprazolam and another CNS depressant, they may prescribe an alprazolam dosage that's lower than usual. They may also recommend only taking the combination for a short time. Do not take either drug in a higher dose or for a longer length of treatment than your doctor recommends.»Read about alternatives to Xanax for sleep.Mild or moderate CYP3A inhibitorsAlprazolam can interact with drugs that are mild or moderate inhibitors of CYP3A, an enzyme that helps break down alprazolam. Mild or moderate inhibitors of CYP3A slow the action of this enzyme.Taking alprazolam with a mild or moderate CYP3A inhibitor can cause alprazolam to build up in your body. This interaction can raise your risk of serious side effects of alprazolam, such as drowsiness or difficulty breathing.Here are some examples of mild or moderate CYP3A inhibitors that may interact with alprazolam:certain antibiotics, such as clarithromycin and erythromycincertain antifungals, such as itraconazole (Sporanox) and ketoconazolecimetidine (Tagamet HB)fluvoxaminecertain blood pressure medications, such as diltiazem (Cardizem) and amlodipine (Norvasc)Steps you or your doctor may takeYour doctor will usually avoid prescribing alprazolam with drugs that are mild or moderate CYP3A inhibitors. If you do take alprazolam with one of these drugs, your doctor may prescribe a dosage of alprazolam that's lower than usual. Do not take a higher dosage of either drug than your doctor prescribes.Note: Taking alprazolam with strong inhibitors of CYP3A is not advised. For details, see the section, 'When to avoid alprazolam.'DigoxinAlprazolam can interact with digoxin. Digoxin (Lanoxin) is a medication prescribed to treat atrial fibrillation and heart failure. Taking alprazolam with digoxin can increase the level of digoxin in your body. This can raise the risk of side effects from digoxin. This interaction may be more likely to affect older adults (ages 65 years and older).Steps you or your doctor may takeIf you need to take both alprazolam and digoxin, your doctor may order a blood test to check your digoxin level before you start alprazolam. You may need to get your blood checked often, for as long as you're taking both medications, to make sure your digoxin level stays within a safe range while taking alprazolam. If your digoxin level becomes too high, your doctor will likely lower your dosage of digoxin.Alprazolam and other interactionsAlprazolam may have other interactions, such as with supplements, foods, vaccines, or lab tests. Here are some potential interactions with alprazolam. Keep in mind that the following information does not include all other possible alprazolam interactions.Alprazolam interactions with supplementsBefore you start treatment with alprazolam, tell your doctor and pharmacist about any supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.Alprazolam interactions with herbsDoctors will typically recommend you avoid taking St. John's wort with alprazolam. St. John's wort is an herbal supplement that may be used for depression and other conditions.St. John's wort may speed up the activity of CYP3A4, an enzyme that helps break down alprazolam in your body.By speeding up this enzyme, St. John's wort can cause alprazolam to break down more quickly. This may lead to a low level of alprazolam in your system. If the alprazolam level is too low, the drug may not work as well to manage your anxiety or panic disorder. This interaction may also lead to withdrawal symptoms (uncomfortable side effects that can occur when you stop taking a drug your body is used to).Your doctor may be able to suggest a treatment option other than St. John's wort.»Learn more: What happens when you stop taking benzodiazepines?Alprazolam interactions with vitamins There are no specific reports of vitamins or minerals interacting with alprazolam. However, that doesn't mean vitamin interactions won't occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with alprazolam.Alprazolam interactions with foodGrapefruit and grapefruit juice can interact with alprazolam. Specifically, grapefruit products can stop your body from breaking down alprazolam. This raises the level of alprazolam in your body, which increases your risk of side effects from alprazolam. Due to this risk, your doctor may recommend not consuming grapefruit and grapefruit juice while taking the drug.Alprazolam may also interact with caffeine. Consuming caffeine while taking alprazolam could make alprazolam less effective. Foods and beverages that contain caffeine include:coffeeteachocolateenergy drinksBecause of this interaction, your doctor may recommend limiting how much caffeine you consume while taking alprazolam. Or they may recommend avoiding caffeine at certain times of day. For example, if you take alprazolam at bedtime, your doctor may recommend avoiding caffeine in the afternoon and evening.If you'd like to learn more about eating certain foods during treatment with alprazolam, talk with your doctor.Alprazolam interactions with vaccinesThere aren't any known interactions between alprazolam and vaccines. Talk with your doctor or pharmacist to check whether you're due for any vaccines.Alprazolam interactions with lab testsAlprazolam isn't known to interact with lab tests. If you have concerns about this medication interacting with lab tests, talk with your doctor.ALPRAZOLAM INTERACTION WITH CANNABIS OR CBDCannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Xanax, the brand-name version of alprazolam. The combination can raise the risk of side effects from alprazolam and cannabis, such as drowsiness.Before you start treatment with Alprazolam, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.Alprazolam and health-related interactionsCertain medical conditions and other factors may increase the risk of interactions with alprazolam. Before you take this drug, be sure to talk with your doctor about your health history. Alprazolam may not be the right treatment option if you have certain medical conditions or other factors affecting your health.Health conditions or factors that might interact with alprazolam include:Older age: If you're age 65 years or older, your doctor may prescribe a dosage of alprazolam that is lower than usual. This is because people in this age range may have a higher risk of side effects with this drug.Allergic reaction: If you've had an allergic reaction to alprazolam, any of its ingredients, or other benzodiazepine drugs, your doctor will likely not prescribe alprazolam. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be a better option for you.Breathing problems: If you have lung problems, such as sleep apnea, you may have a higher risk of difficulty breathing while taking alprazolam. Talk with your doctor about any breathing problems you have to help determine whether this medication is safe for you.Liver or kidney problems: If you have liver or kidney problems, alprazolam could stay in your system longer than usual. This can increase the risk of side effects. Tell your doctor if you have kidney or liver problems, such as alcohol-related liver disease. They may prescribe a lower dosage of alprazolam or recommend a different treatment option for you.Pregnancy: There haven't been enough clinical trials to determine whether alprazolam is safe to take while pregnant. Some reports suggest that taking the drug during the later stages of pregnancy may cause serious side effects in a newborn. If you're pregnant or planning to become pregnant, tell your doctor before starting alprazolam. They can advise you on the right treatment plan for you.Breastfeeding: Your doctor will likely recommend that you do not breastfeed while taking alprazolam. The drug may pass into breast milk. Some reports suggest that taking the drug while breastfeeding may cause serious side effects in a child who is breastfed. If you're breastfeeding or planning to, talk with your doctor before taking alprazolam. They can talk with you about treatment options and ways to feed a child other than breastfeeding.Driving or operating machinery: Your doctor will likely recommend that you do not drive while taking alprazolam. The drug can reduce your ability to safely drive or operate machinery.Risks of misuse, addiction, dependence, withdrawal, and opioid interaction: Alprazolam has several boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous. For details, see the boxed warnings at the top of this article.Depression or mental illness: If you have depression, another mental health condition, or have had suicidal thoughts or behaviors, tell your doctor before starting alprazolam. People with these conditions may have a higher risk of suicidal thoughts and behaviors if they take alprazolam. Your doctor may take extra precautions to make sure alprazolam is safe for you, such as more frequent appointments to check on your mental health. Help is out thereIf you or someone you know is in crisis and considering suicide or self-harm, please seek support:Call or text the 988 Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.Not in the United States? Find a helpline in your country with Befrienders Worldwide.Call 911 or your local emergency services number if you feel safe to do so.If you're calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.If you're not in the same household, stay on the phone with them until help arrives.Preventing interactionsYou can take certain steps to help prevent interactions with alprazolam. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:Let them know if you drink alcohol or use cannabis.Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.Create a medication list, which your doctor and pharmacist can help you fill out.It's also important to read the alprazolam label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. The paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.If alprazolam doesn't come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.You can also help prevent interactions with alprazolam by taking it exactly as your doctor prescribes.Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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