This article describes possible interactions with alprazolam. Interactions can cause a drug to have a different effect on the body than expected. Interactions can occur due to medications, alcohol, or certain health conditions.
Alprazolam comes as tablets that you’ll swallow or tablets that dissolve in your mouth. It’s also available as a liquid solution concentrate and an extended-release tablet that you swallow. (Extended release means the drug is slowly released into your body over a long period of time).
Alprazolam has several boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For details, see the end of this article.
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Other drugs and alprazolam
The drugs in the list below may interact with alprazolam. This article doesn’t include all drugs that may interact with alprazolam.
Drug classes or drugs that may interact with alprazolam include:
- antihistamines:
- drug examples: diphenhydramine (Benadryl), chlorpheniramine
- what might happen: can increase the risk of central nervous system (CNS) depression (slowing down of your brain and nervous system) as a side effect of alprazolam and the antihistamine drug
- antipsychotic medications:
- drug examples: haloperidol (Haldol), loxapine (Adasuve)
- what might happen: can increase the risk of CNS depression as a side effect of alprazolam and the antipsychotic drug
- certain antiepileptic drugs:
- drug examples: phenytoin (Dilantin), carbamazepine (Tegretol, others)
- what might happen: can make alprazolam less effective
- certain antidepressants:
- drug examples: nefazodone, fluvoxamine (Luvox)
- what might happen: can increase the risk of side effects of alprazolam
- opioids:*
- drug examples: morphine (MS Contin, others), hydromorphone (Dilaudid)
- what might happen: can increase the risk of respiratory depression (slow, shallow breathing) and other serious side effects of alprazolam
- certain antibiotics:
- drug examples: clarithromycin,† erythromycin (Eryc, others)
- what might happen: can increase the risk of side effects of alprazolam
- certain antifungal drugs:
- drug examples: ketoconazole,† itraconazole† (Sporanox, Tolsura)
- what might happen: can increase the risk of side effects of alprazolam
- cobicistat (Tybost)† and drugs that contain it:
- ritonavir (Norvir) and drugs that contain it:
- drug examples: ritonavir/nirmatrelvir (Paxlovid), lopinavir/ritonavir (Kaletra)
- what might happen: can increase the risk of side effects of alprazolam
- digoxin (Lanoxin):
- what might happen: can increase the effect and risk of side effects of digoxin
* Alprazolam has a boxed warning about this interaction. A boxed warning is the most serious warning from the FDA. For details, see the end of this article.
† Taking this drug with alprazolam is contraindicated. To learn more, see “When to avoid alprazolam” section below.
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Get free cardWhen to avoid alprazolam
Certain health conditions or other factors could increase some risks with alprazolam. Because of this, doctors may not prescribe alprazolam in these cases. These health conditions or other factors are called contraindications.
Here’s a list of contraindications for alprazolam:
- Taking strong CYP3A4 inhibitors: Drugs that are strong CYP3A4 inhibitors (blockers) can increase the amount of alprazolam in your system. This can increase your risk of side effects from alprazolam. Examples of these drugs include clarithromycin, erythromycin, ketoconazole, and itraconazole. Your doctor or pharmacist can review your medication list to check if any of them have this effect.
- Past allergic reaction to alprazolam: If you’ve ever had an allergic reaction to alprazolam or other benzodiazepines, taking it again may cause another allergic reaction. (Alprazolam belongs to a group of drugs called benzodiazepines.)
Before you start taking alprazolam, talk with your doctor about the contraindications of the drug. They can recommend whether you should take it.
Alcohol and alprazolam
Alprazolam is known to interact with alcohol. You should avoid consuming alcohol while taking alprazolam.
Taking alprazolam and drinking alcohol may cause severe CNS depression. This can lead to side effects such as:
- problems with balance, concentration, and decision-making
- respiratory depression
- slurred speech
Combining alcohol and alprazolam can increase the risk of alprazolam overdose, which can be life threatening.
If you drink alcohol and have concerns about avoiding it while taking alprazolam, talk with your doctor.
Other interactions and alprazolam
Interactions can occur with supplements, foods, vaccines, and some lab tests. Below you can learn whether alprazolam has these interactions.
The information below doesn’t include all other possible interactions with alprazolam.
Alprazolam and supplements
Before taking alprazolam, tell your doctor and pharmacist about any herbs you take, as well as vitamins and supplements. Doing so may help you avoid interactions.
In addition to the interactions described below, alprazolam may interact with gamma aminobutyric acid (GABA) supplements. These supplements are used to ease symptoms of stress and anxiety, and to aid sleep.
Like alprazolam, GABA supplements can cause drowsiness. Taking them together may worsen this effect. So, your doctor may recommend you avoid taking a GABA supplement if you’re prescribed alprazolam.
If you have questions about interactions that may affect you, talk with your doctor or pharmacist.
Alprazolam and herbs
Alprazolam may interact with St. John’s wort. This herb is often used for easing symptoms of depression and other conditions. Taking alprazolam and using St. John’s wort may make alprazolam less effective.
Alprazolam may also interact with valerian (also called valerian root) supplements. Valerian is used to aid sleep. Because both alprazolam and valerian can cause drowsiness, combining the two may worsen this effect.
Because of this, ask your doctor or pharmacist before using any of these products while taking alprazolam.
Alprazolam and vitamins
Alprazolam isn’t known to interact with any vitamins. But this doesn’t mean interactions with vitamins can’t happen or won’t be identified later.
Because of this, ask your doctor or pharmacist before using any of these products while taking alprazolam.
Alprazolam and food
Alprazolam can interact with grapefruit and grapefruit juice. Grapefruit and grapefruit juice can increase the amount of alprazolam in your system. This raises your risk of side effects, including serious effects such as respiratory depression. Due to this risk, you should avoid consuming grapefruit or grapefruit juice while taking alprazolam.
Because of this, talk with your doctor or pharmacist about what foods you should avoid while taking alprazolam.
Alprazolam and vaccines
Alprazolam isn’t known to interact with any vaccines. But this doesn’t mean interactions with vaccines can’t happen or won’t be identified later.
Because of this, talk with your doctor or pharmacist before receiving any vaccines while taking alprazolam.
Alprazolam and lab tests
Alprazolam isn’t known to interact with lab tests. But this doesn’t mean interactions with lab tests can’t happen or won’t be identified later.
Because of this, talk with your doctor or pharmacist before having any tests while taking alprazolam.
Alprazolam and cannabis or CBD
Studies of cannabis (commonly called marijuana) and cannabis products have been shown to interact with alprazolam. Cannabidiol (CBD) is an example of a cannabis product.
Taking alprazolam and using cannabis may increase or decrease the effect of alprazolam. This combination can also increase the risk of side effects of alprazolam and cannabis, including CNS depression.
Before you take alprazolam, tell your doctor and pharmacist if you use cannabis. Doing so may help prevent possible interactions.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
Health factors and alprazolam
Certain medical conditions or other health factors may increase the risk of interactions with alprazolam. Keep in mind that interactions could lead to side effects or affect how well the drug works. Before taking alprazolam, tell your doctor about your health history. They’ll determine whether alprazolam is right for you.
These health conditions or other factors might interact with alprazolam:
- breathing or lung conditions, such as asthma or sleep apnea
- kidney conditions, such as chronic kidney disease
- liver conditions, such as cirrhosis
- substance use disorder
- pregnancy or breastfeeding
- past allergic reaction to alprazolam
- mental health conditions, including depression or bipolar disorder
- suicidal thoughts or behaviors
Suicide prevention
If you or someone you know is in crisis and considering suicide or self-harm, please seek support:
- Call the 988 Suicide and Crisis Lifeline at 988.
- Text HOME to the Crisis Text Line at 741741.
- 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 are not in the same household, stay on the phone with them until help arrives.
Preventing alprazolam interactions
You may be able to help avoid certain interactions with alprazolam. Before taking this drug, you may want to discuss possible interactions with your doctor and pharmacist.
Things to consider include:
- Whether you drink alcohol or use cannabis.
- Other medications and herbs you take, as well as vitamins and supplements. Your doctor or pharmacist can help you fill out a medication list.
- What to do if you’re prescribed a new drug while taking alprazolam.
Taking alprazolam exactly as prescribed can also help prevent interactions.
Boxed warnings for alprazolam
This drug has several boxed warnings. A boxed warning is the most serious warning from the FDA.
Risk of serious side effects if taken with opioids: Serious side effects can occur if alprazolam is taken together with opioids. This combination can increase your risk of respiratory depression (slow, shallow breathing), coma, and death in certain cases.
Because of this risk, doctors typically avoid prescribing alprazolam with an opioid unless no other treatment options are suitable. If this combination must be prescribed, doctors will prescribe the lowest dose of alprazolam and the opioid needed to treat symptoms. If you must take an opioid with alprazolam, talk with your doctor about naloxone (Narcan). It’s a drug that can be used in an emergency to block the effects of opioids until emergency responders arrive.
Risk of misuse and addiction: Like other benzodiazepines, alprazolam has a risk of misuse and addiction. With misuse, a drug is taken in a way other than how it’s prescribed. With addiction, you continue taking a drug despite it causing harm.
Because of this risk, alprazolam is a controlled substance. Doctors and pharmacists must follow strict rules regarding how alprazolam is prescribed and dispensed. These rules are in place to help prevent misuse and addiction. Let your doctor know if you have a substance use disorder before you start taking alprazolam. Your doctor may decide to prescribe a different treatment for your condition instead.
Risk of dependence and withdrawal: Similar to other benzodiazepines, alprazolam has a risk of dependence and withdrawal. With dependence, your body needs the drug in order to function like usual. Withdrawal describes symptoms that can occur when you stop taking a drug your body is dependent on. Your risk of dependence increases if you take a higher alprazolam dose or take the drug long term. However, dependence and withdrawal can happen if you take the drug short term as well. In rare cases, withdrawal symptoms can last for 12 months or longer after stopping the drug.
To lower your risk of withdrawal, do not suddenly stop taking alprazolam. Instead, talk with your doctor if you’re interested in stopping it. Your doctor can develop a plan to safely lower your alprazolam dose over time before stopping it completely.
To learn more about these warnings, talk with your doctor.
Disclaimer: Optum Perks 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.