Alprazolam Interactions: Alcohol, Medications, and Others

Does alprazolam interact with other drugs?

Before you start taking alprazolam, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether alprazolam interacts with herbs, vitamins, or supplements, see the “Are there other interactions with alprazolam?” section.)

If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.

The following table lists drugs that may interact with alprazolam. Keep in mind that this table does not include all drugs that may interact with alprazolam. For more information about some of these interactions, see the “Drug interactions explained” section.

* Alprazolam has a boxed warning about risks if taken with opioids. To learn more, see the “Boxed warnings” section.
† Your doctor likely won’t prescribe alprazolam with certain drugs used to treat infection. See the “When should I avoid alprazolam?” section for details.

When should I avoid alprazolam?

Certain health conditions or other factors could raise your risk of harm if you take alprazolam. In such cases, your doctor may not prescribe alprazolam for you. These are known as contraindications. The following list includes contraindications of alprazolam.

If you take certain drugs used to treat infection: If you take certain drugs for a bacterial infection, fungal infection, or HIV, your doctor likely won’t prescribe alprazolam for you. This is because some of these drugs can prevent your body from breaking down alprazolam correctly. This can make alprazolam build up in your body, which can raise your risk of serious side effects from alprazolam. (To learn more about the drug’s potential side effects, see this alprazolam side effects article.)

Examples of drugs used to treat infection that can interact with alprazolam in this way include:

• certain antibiotics, such as clarithromycin
• certain antifungals, such as ketoconazole and itraconazole (Sporanox)
• certain HIV medications, such as nelfinavir (Viracept) and atazanavir (Reyataz)

If you take medication for an infection, talk with your doctor before taking alprazolam. Your doctor will check whether it’s safe for you to take alprazolam with your other medications.

If you’ve had an allergic reaction: If you’ve had an allergic reaction to alprazolam or any of its ingredients, your doctor likely won’t prescribe alprazolam for you. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.

Your doctor also likely won’t prescribe alprazolam if you’ve had an allergic reaction to another drug from the same drug class as alprazolam (called benzodiazepines). This is because taking alprazolam could cause another allergic reaction.

Examples of other benzodiazepines include diazepam (Valium) and clonazepam (Klonopin).

Before you start taking alprazolam, talk with your doctor if either of these factors applies to you. Your doctor can determine whether alprazolam is safe for you to take.

Does alprazolam interact with alcohol?

You should not drink alcohol during your alprazolam treatment. Combining the drug with alcohol can cause serious side effects, including:

• severe sleepiness
• reduced awareness
• unresponsiveness
• slow, shallow, or weak breathing

In some cases, combining alcohol and alprazolam can lead to coma or be fatal.

If you have concerns about avoiding alcohol while taking alprazolam, talk with your doctor or pharmacist.

Drug interactions explained

Learn more about certain drug interactions that can occur with alprazolam.

Interaction with blood pressure medications

Alprazolam can interact with certain blood pressure medications. Some of these medications can prevent your body from breaking down alprazolam correctly. This can make alprazolam build up in your body, which can raise your risk of side effects from the drug, such as sleepiness, dizziness, and coordination problems.

Examples of blood pressure medications that can prevent your body from breaking down alprazolam correctly include:

• amlodipine (Norvasc, others)
• diltiazem (Cardizem CT, others)
• verapamil (Verelan)

Also, both alprazolam and blood pressure medications can cause dizziness, and alprazolam can cause coordination problems. So taking alprazolam with blood pressure medications may raise your risk of dizziness or make dizziness worse. It may also raise your risk of falling.

What you can do

If your doctor has you take alprazolam with certain blood pressure medications, they may prescribe a lower dosage of alprazolam or the blood pressure medication for you. You should not take a higher dose of either medication than your doctor prescribes.

If you take alprazolam and a blood pressure medication together, tell your doctor right away if you have new or worsening dizziness.

If you have questions about taking alprazolam with a blood pressure medication, talk with your doctor or pharmacist.

Interaction with other CNS depressants

Alprazolam is a central nervous system (CNS) depressant. This means it slows activity in your brain and spinal cord. Several types of drugs are CNS depressants. These drugs can cause side effects such as sleepiness, slurred speech, and coordination problems.

Taking alprazolam with other CNS depressants can slow activity in your brain and spinal cord even more. This could increase your risk of side effects (such as sleepiness) or make the side effects that you experience worse. It can also lead to more serious side effects, such as slowed breathing.

Examples of CNS depressants that may interact with alprazolam include:

• opioids* such as morphine (MS Contin) and hydrocodone (Hysingla ER)
• antipsychotics, such as haloperidol (Haldol) and risperidone (Risperdal)
• certain muscle relaxants, such as carisoprodol (Soma) and cyclobenzaprine (Amrix)
• seizure medications, such as gabapentin (Neurontin) and topiramate (Topamax)
• sleep medications, such as zolpidem (Ambien) and suvorexant (Belsomra)
• certain antihistamines, such as chlorpheniramine and promethazine

* Alprazolam has a boxed warning about the risk of serious side effects if taken with opioids. To learn more, see the “Boxed warnings” section.

What you can do

If you take alprazolam with other CNS depressants, your doctor may prescribe a lower dosage of alprazolam for you. You should not take a higher dose of either medication than your doctor prescribes.

If your doctor has you take alprazolam and another CNS depressant together, seek medical help right away if you become very sleepy or confused, or have slow, shallow, or weak breathing.

If you have questions about taking alprazolam with other CNS depressants, talk with your doctor or pharmacist.

Interaction with certain seizure medications

Alprazolam can interact with certain seizure medications. Some of these medications can make your body break down alprazolam faster than usual. This can lower the level of alprazolam in your body, which can make the drug less effective.

Examples of seizure drugs that can make alprazolam less effective include:

• carbamazepine (Tegretol, others)
• phenobarbital (Sezaby)
• phenytoin (Dilantin, Phenytek)

Seizure medications are also CNS depressants (see “Interaction with other CNS depressants” in this section for details). So taking alprazolam with seizure medications can raise your risk of severe sleepiness and slowed breathing.

What you can do

If your doctor has you take alprazolam with one of the seizure medications it interacts with, they will likely monitor you closely to make sure alprazolam is working for you.

If you take alprazolam and a seizure medication together, seek medical help right away if you become very sleepy or confused, or have slow, shallow, or weak breathing.

If you have questions about taking these drugs together, talk with your doctor or pharmacist.

Are there other interactions with alprazolam?

Alprazolam may have other interactions. They could occur with supplements, foods, vaccines, or lab tests.

The following are additional interactions that may occur with alprazolam. Note that this information does not include all other possible interactions with alprazolam.

Does alprazolam interact with supplements?

Alprazolam can interact with supplements used to aid sleep, such as melatonin and valerian. Alprazolam can cause sleepiness, so taking it with sleep aid supplements may cause excessive sleepiness. Your doctor will likely recommend that you do not take sleep aid supplements during your alprazolam treatment.

Before you start treatment with alprazolam, talk with your doctor and pharmacist about any herbs, vitamins, or supplements you take. Sharing this information with them may help you avoid possible interactions.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Alprazolam interactions with herbs

Alprazolam can interact with St. John’s wort, which may be used to help ease symptoms of depression and other conditions.

St. John’s wort can make your body break down alprazolam faster than usual. This can lower the level of alprazolam in your body, which can make the drug less effective. Because of this, your doctor will likely recommend that you do not take St. John’s wort during your alprazolam treatment.

Alprazolam interactions with vitamins

There are currently no reports of alprazolam interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.

For this reason, it’s important to check with your doctor or pharmacist before taking any of these products while taking alprazolam.

Does alprazolam interact with food?

Alprazolam can interact with grapefruit and grapefruit juice. Consuming grapefruit products with alprazolam can prevent your body from breaking down alprazolam correctly. This can make alprazolam build up in your body, which can raise your risk of side effects from the drug, such as sleepiness, dizziness, and coordination problems.

If you have questions about consuming other foods or drinks during your treatment with alprazolam, talk with your doctor.

Does alprazolam interact with vaccines?

There are currently no reports of alprazolam interacting with vaccines. If you have questions about receiving certain vaccines during your alprazolam treatment, talk with your doctor.

Does alprazolam interact with lab tests?

There are currently no reports of alprazolam interacting with lab tests. If you have questions about having certain lab tests done during your treatment with alprazolam, talk with the healthcare professional ordering the test.

Does alprazolam interact with cannabis or CBD?

Cannabis (commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with alprazolam.

Cannabis products can prevent your body from breaking down alprazolam as well as usual. This can make alprazolam build up in your body, which can raise your risk of side effects from alprazolam. Examples include sleepiness, dizziness, and coordination problems. Cannabis and cannabis products can also cause these side effects.

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.

Does my health history affect whether I should take alprazolam?

Certain medical conditions or other health factors may raise the risk of interactions with alprazolam. Before starting alprazolam, talk with your doctor about your health history. They’ll determine whether alprazolam is right for you.

Health conditions or other factors that might interact with alprazolam include:

Driving and operating machinery: Alprazolam can cause various side effects that may reduce your ability to drive or operate machinery safely. These side effects include reduced alertness, drowsiness, and coordination problems. If you need to drive or operate machinery, talk with your doctor about whether it’s safe for you to take alprazolam.

Past drug or alcohol misuse or addiction: Alprazolam has a boxed warning for risks of misuse and addiction. To learn more, see the “Boxed warnings” section. If you have a history of drug or alcohol misuse or addiction, your risk of these issues may be higher. Talk with your doctor before taking alprazolam.

Depression or bipolar disorder: If you have depression or bipolar disorder, taking alprazolam could worsen your condition. Talk with your doctor about whether alprazolam is right for you.

Breathing problems: If you have a breathing problem such as chronic obstructive pulmonary disease (COPD) or sleep apnea, taking alprazolam could worsen your condition. Talk with your doctor about whether alprazolam is right for you.

Liver problems: If you have a liver problem, alprazolam can build up in your body. This can raise your risk of side effects from the drug. Because of this, your doctor may prescribe a lower dosage of alprazolam for you.

Age 65 years or older: If you’re age 65 years or older, you may be more sensitive to the side effects of alprazolam. Because of this, your doctor may prescribe a lower dosage of alprazolam for you. Talk with your doctor to learn more.

Pregnancy: It’s not known whether alprazolam is safe to take during pregnancy. If taken in the last trimester of pregnancy, the drug may cause side effects in the baby after birth. For example, the newborn may have withdrawal symptoms, difficulty breathing, severe sleepiness, or difficulty feeding. If you’re pregnant or planning a pregnancy, talk with your doctor before taking alprazolam.

Breastfeeding: Your doctor will likely recommend that you do not take alprazolam while breastfeeding. The drug passes into breast milk and can cause side effects in a child who is breastfed. If you’re breastfeeding or planning to do so, talk with your doctor about your options.

Allergic reaction: If you’ve had an allergic reaction to alprazolam (or any of its ingredients) or to other benzodiazepines, your doctor will likely not prescribe alprazolam. This is because taking alprazolam could cause another allergic reaction. Examples of other benzodiazepines include diazepam (Valium) and clonazepam (Klonopin). To learn more about your risk of an allergic reaction to alprazolam, talk with your doctor or pharmacist.

How can I prevent interactions?

Taking certain steps can help you avoid interactions with alprazolam. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

• whether you drink alcohol or use cannabis
• the list of medications you take, as well as any vitamins, supplements, and herbs
• what to do if you start taking a new drug during alprazolam treatment

It’s also important to understand alprazolam’s label and other paperwork that may come with the drug. Colored stickers that describe interactions may be on the label. The paperwork, sometimes called the patient package insert or medication guide, may have other details about interactions.

If you did not get paperwork with alprazolam, ask your pharmacist to print a copy for you. If you have trouble reading or understanding this information, your doctor or pharmacist can help.

Taking alprazolam exactly as prescribed can also help prevent interactions.

Disclaimer: Healthline 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.