What Drugs Interact With Xanax (Alprazolam)?

Alprazolam is one of a few prescription drugs that have a high potential for substance abuse with other drugs. But those other drugs, even other prescription medications, can have adverse effects when taken with Xanax.

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Dr. Manish Mishra, MBBS

Medically Reviewed By: Manish Mishra, MBBS


Xanax or Niravam (alprazolam) is a powerful anti-anxiety medication in the benzodiazepine class of drugs.

It works quickly to counteract symptoms of a panic disorder or mental disorders like agoraphobia by elevating the body’s naturally occurring gamma-aminobutyric acid (GABA) levels.

Because alprazolam is so effective at treating the symptoms of panic attacks, it can be habit-forming, and Xanax addiction tends to grow around other forms of drug abuse.

Mixing Xanax With Prescription Medications

Xanax is a potent prescription drug that you should handle carefully. Inform your healthcare provider of all the prescription medications that you take because interactions can lead to serious side effects.

If you have any doubts, even with over-the-counter medications, get medical advice.

Xanax And Other Depressant Medications

Xanax is one of many types of drugs called central nervous system depressants.

The three categories of CNS depressants are:

  • benzodiazepines, including Klonopin (clonazepam), Valium (diazepam) and Ativan (lorazepam)
  • non-benzodiazepine sedative hypnotics, such as zolpidem
  • barbiturates like mephobarbital and phenobarbital

Taking multiple drugs in this category can have a compounded impairment of the central nervous system.

Xanax And Viagra

Alprazolam and Viagra (sildenafil) can conflict with each other. Viagra is for erectile dysfunction (ED), but Xanax has been linked to causing ED.

Also, while there are no specific drug warnings, Viagra increases blood flow and Xanax has a side effect of elevated heart rate.

Xanax And Adderall

Similarly, Xanax and Adderall can counteract each other.

Adderall is an amphetamine stimulant drug typically prescribed to treat ADHD or encourage weight loss, and it can heighten anxiety that Xanax is meant to reduce.

Gabapentin And Xanax

Gabapentin seems to do what alprazolam does in that it affects GABA, but studies on these effects are inconclusive. Nevertheless, as an anticonvulsant drug, Gabapentin suppresses the CNS.

When Gabapentin is taken with Xanax, people can expect a heightened feeling of such side effects as:

  • dizziness
  • drowsiness
  • difficulty concentrating
  • poor coordination

Cimetidine And Xanax

Cimetidine is an antihistamine that medical professionals prescribe to treat such medical conditions as stomach acidity and ulcers.

Cimetidine can heighten and lengthen the side effects of alprazolam and other triazolobenzodiazepines, such as triazolam.

If taken together Xanax and cimetidine can increase and lengthen:

  • drowsiness
  • dizziness
  • confusion

Trazodone And Xanax

Trazodone is used to treat similar conditions as Xanax is, except that trazodone, like other antidepressants, regulates serotonin instead of GABA.

But the side effects of both medications are similar. If you take Xanax and trazodone together, you may experience a heightened state of confusion, drowsiness, and cognitive impairment, as well as poor judgment and coordination.

Fluvoxamine And Xanax

When taken with Xanax, fluvoxamine as well as nefazodone or fluoxetine are serotonin uptake inhibitors.

They can not only heighten the side effects of alprazolam, but also can increase its half-life. This means that it takes longer for Xanax to clear your system.

Xanax And Ketoconazole

Ketoconazole (as well as itraconazole) are antifungal creams, so it may be surprising that there is an interaction between two seemingly unrelated drugs.

But these antifungal creams increase concentrations of the type of plasma that metabolizes alprazolam, resulting in sedation and causing breathing problems as well as poor coordination.

Carbamazepine And Xanax

Carbamazepine appears to be an effective medication-assisted treatment for alprazolam withdrawal syndrome in that it seems to counteract what Xanax does.

Taking Xanax with carbamazepine would reduce the former’s efficacy with panic attacks.

Sleeping Pills And Xanax

A common side effect of Xanax is sedation (sleepiness or drowsiness), a natural result of its work as a CNS depressant.

You should never take Xanax and sleeping pills, especially if you have sleep apnea.

The two drugs working together could cause dangerous respiratory depression resulting in a call to poison control and the need for medical help.

Risks Of Mixing Xanax With Illicit Drugs

Xanax should never be taken with illicit drugs under any circumstances, especially if you are taking a high dose of alprazolam or extended-release tablets (Xanax XR).

It could interact dangerously with illicit drugs and intensify certain side effects of Xanax.

Xanax And Cocaine

A side effect of Xanax abuse is an elevated heart rate, low blood pressure, and other pulmonary problems such as heart palpitations and heart attacks.

These are also common side effects of using cocaine. Someone might take Xanax with cocaine to try to curb the intense edgy feeling and instead intensify dangerous heart problems.

Heroin And Xanax

Heroin and Xanax both depress brain function. Heroin does this through the opioid receptors of the brain while Xanax increases GABA.

Both can result in slow breathing and, when taken together, they can depress your respiratory system to dangerous and even fatal levels.

Xanax And Marijuana

The side effects of both marijuana and alprazolam, when taken together at high doses, can compound drowsiness and even memory loss.

Other Substances That Interact With Xanax

Prescription drugs and illicit drugs aren’t the only substances that Xanax interacts with. You will want to avoid these other substances as well.

Mixing Xanax And Alcohol

Xanax and alcohol are an especially life-threatening combination, because they both work to suppress the central nervous system.

In fact, the reason some people develop an alcohol use disorder is to counteract anxiety and lower inhibitions.

Dangers Of Mixing Xanax With Grapefruit Juice

Oddly enough, you shouldn’t mix Xanax with grapefruit juice. Grape juice can alter certain blood plasmas that your body uses to metabolize Xanax (as well as some other drugs).

This alteration allows more of it into your system, intensifying the effects.

Taking Xanax With Caffeine

Taking Xanax with caffeine can, at the very least, be counterproductive. Caffeine tends to heighten the symptoms of anxiety that Xanax is meant to reduce.

At the worst, caffeine can mask the work of alprazolam, causing you to take more of the drug to get the same effect.

Treatment Programs For Xanax Addiction

Mixing your Xanax with other substances is a sign of substance abuse or addiction.

You can receive treatment for Xanax addiction from a qualified treatment center that will address all aspects of substance abuse.

Many treatment plans include:

  • inpatient or outpatient treatment
  • treatment of co-occurring mental health problems (sometimes exploring the use of supplements for anxiety and depression, like St. John’s Wort)
  • detox supervised by healthcare professionals
  • management of withdrawal symptoms
  • support groups
  • evidence-based therapy

Find Substance Use Disorder Treatment At Bedrock Recovery Center

At Bedrock Recovery Center, we know that part of the difficulty of a benzodiazepine addiction can be the generalized anxiety disorder that underlies the use of the drug.

Located on the east coast, we bring years of experience to crafting a treatment plan that fits your needs and addresses both physical dependence and addiction.

Call our helpline today to get the help that you or your loved one needs.

  1. European Journal of Clinical Pharmacology https://pubmed.ncbi.nlm.nih.gov/8005185/
  2. Food and Drug Administration (FDA) https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/018276s044,021434s006lbl.pdf
  3. Food and Drug Administration (FDA) https://www.fda.gov/consumers/consumer-updates/grapefruit-juice-and-some-drugs-dont-mix
  4. Journal of Addiction Medicine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846112/
  5. Journal of Experimental Pharmacology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5308580/

Written by Bedrock Recovery Center Editorial Team

© 2024 Bedrock Recovery Center | All Rights Reserved

* This page does not provide medical advice.

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