---
title: "Alprazolam Interactions: Drugs & Foods Not To Mix With Xanax"
description: "Alprazolam, also known as Xanax, is an anxiety medication with many drug interactions; it is essential to understand what you shouldn’t take with it."
authors:
  - "Dorianne Green"
reviewers:
  - "Dr. Henry Bradford"
date: "2025-04-30 15:35:20"
canonical: "https://medvidi.com/blog/alprazolam-interactions"
categories:
  - "Anxiety"
  - "Medications"
---

# Alprazolam Interactions: What to Avoid

The medications listed on this website are provided for informational purposes only.Their inclusion does not guarantee they will be prescribed to any individual, as treatment decisions are ultimately at the discretion of healthcare providers. Healthcare providers may prescribe other medications or recommend non-pharmacological treatment based on the patient’s unique health circumstances and needs. [Read more](#)

 Boxed warning: Xanax (alprazolam) Xanax has a** [boxed warning](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d9b0e228-17cf-40d7-b62e-5050311c571c)**, the most serious type of warning from the Food and Drug Administration (FDA). Xanax’s active ingredient alprazolam can cause profound sedation and respiratory depression if used with opioids; it has a risk of abuse, misuse, addiction, physical dependence, and withdrawal reactions. Xanax is also a controlled substance, indicating its high potential for misuse or dependence. Specific federal and state laws limit the amount of this medication that can be prescribed or dispensed within a certain period of time.

 
### Highlights
 
 1. Usually, a doctor prescribes Xanax (alprazolam) as a second-line treatment for anxiety disorders such as generalized anxiety disorder and panic disorder; sometimes it is used off-label for other mental health conditions. 2. Taking alprazolam can cause common side effects, such as tiredness, dizziness, forgetfulness, and difficulty concentrating. 3. Xanax interacts with many prescribed and over-the-counter medications, including herbal supplements, and food; therefore, it is essential to inform your doctor about all treatments you are taking and to read the patient package insert. 
 To understand which medications you cannot take with Xanax (alprazolam), you need to know why they might cause a problem. Interactions can be broken down into two types:

 
 1. Medications that interfere with the breakdown of alprazolam. 2. Other CNS depressants can intensify alprazolam’s side effects. 
 There is one class of drugs, opioids, that can have both of these interactions and be life-threatening if used with alprazolam.

 Let’s start with the basics of alprazolam, how it’s metabolized, and then move on to the medications you should avoid and why.

 Personalized care for anxiety Get all your questions about anxiety treatment answered online by a licensed medical provider. [Book an appointment](https://join.medvidi.com/signup) * 
## A Brief Overview of Alprazolam
 [Xanax](https://medvidi.com/drugs/xanax/), also known as alprazolam, is a [benzodiazepine medication](https://medvidi.com/blog/benzodiazepines) that has a relaxing effect on the central nervous system (CNS), which includes the brain and spinal cord. It causes CNS depression by increasing the activity of GABA (gamma aminobutyric acid), the [brain’s primary calming nerve](https://www.ncbi.nlm.nih.gov/books/NBK513311/) messenger; alprazolam is also known as a ‘downer.’

 The Food and Drug Administration (FDA) has [only approved alprazolam for](https://www.ncbi.nlm.nih.gov/books/NBK538165/) specific anxiety disorders: generalized anxiety disorder and panic disorder.

 Alprazolam tablets come in various forms that [stay in your system](https://medvidi.com/blog/anxiety-meds-how-long-does-xanax-stay-in-your-system) for different lengths of time:

 
 - Immediate-release tablets (to swallow whole) and orally disintegrating tablets (to dissolve under the tongue) that [work for about 5 hours](https://pubmed.ncbi.nlm.nih.gov/17514187/). - Extended-release tablets (like Xanax XR) that [work for about 11 hours](https://pubmed.ncbi.nlm.nih.gov/17514187/). 
 
### Reasons Behind Alprazolam Drug Interactions 
 Alprazolam is broken down (metabolized) in the liver by an enzyme, CYP3A4. Medications and substances called CYP3A4 inhibitors or inducers [might interfere with this](https://www.ncbi.nlm.nih.gov/books/NBK557698/) enzyme, causing drug interactions.

 Another way medication can cause problems is by having similar side effects to alprazolam. As mentioned, Xanax calms the brain and nerves, so can cause both mental and physical adverse effects. These reactions can be worse or life-threatening when using other medication that also relaxes the CNS (CNS depressants).

 Firstly, let’s take a look at some of these interactions and medications to avoid. Later, we’ll discuss the side effects, so that you know what to look out for.

 "It is essential to provide a complete list of all prescription and over-the-counter medications, as well as any supplements you take, when being evaluated by a provider. Drug interactions are common and can significantly influence treatment decisions and dosing." ![Dr. Henry Bradford, MD](https://medvidi.com/wp-content/uploads/2025/02/Dr.-Henry-Bradford-MD.png) [**Dr. Henry Bradford, MD**](/team/dr-henry-bradford/) Medical provider at MEDvidi 
## Alprazolam Interactions With Prescription Medications 
 Below in the table is a quick reference to some medications that could be problematic if used in combination with alprazolam. Importantly, this is not a complete list.

 **Drug Class**

 **Examples**

 **Effects when used with Xanax**

 Opioids

 
 - Morphine, buprenorphine, hydromorphone, oxymorphone, oxycodone, fentanyl, methadone, alfentanil, butorphanol, codeine, dihydrocodeine, meperidine, pentazocine, remifentanil, sufentanil, tapentadol, and tramadol 
 Can cause life-threatening ‘downer’ effects when combined with alprazolam.

 [CYP3A4 Inhibitors](https://www.medsafe.govt.nz/profs/puarticles/march2014drugmetabolismcytochromep4503a4.htm)

 
 - Antibiotics: Clarithromycin*, ciprofloxacin, erythromycin - Antidepressants and other mental health medications: Amitriptyline, fluoxetine, fluvoxamine, paroxetine, risperidone, and haloperidol - Antifungals: Itraconozole* and ketoconazole* - Blood pressure and heart medications: Diltiazem, verapamil, carvedilol, and metoprolol - HIV medication (antiretrovirals): Ritonavir - Cimetidine - [Oral contraceptives](https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/021434s022lbl.pdf) 
 Decrease the breakdown of alprazolam, which can lead to increased side effects.

 CYP3A4 Inducers

 
 - Corticosteroids: Dexamethasone and prednisone  - Antibiotics used to treat tuberculosis: Rifamin - Antifungals: Griseofulvin - HIV medication (antiretrovirals): Neveripine and efavirenz - Anticonvulsants: Carbamazepine, phenytoin  
 Increase the breakdown of alprazolam, which can lead to decreased anxiolytic coverage.

 Central Nervous System (CNS) Depressants

 
 - Other benzodiazepines: Diazepam, lorazepam, oxazepam, clonazepam etc. - Sleeping medications or “Z-drugs”: Eszopiclone, zaleplon, and zolpidem - Muscle relaxants: Baclofen, orphenadrine and diazepam - Antidepressants: Mirtazapine and trazodone, Cyclobenzaprine - Anticonvulsants: Topiramate, pregabalin, phenobarbital 
 Have the same side effects as alprazolam, so might worsen ‘downer’ effects.

 

 Central Nervous System (CNS) Stimulants

 
 - ADHD stimulants: Amphetamines and methylphenidate 
 These medications have the opposite effects to alprazolam, so might worsen anxiety.

 Digoxin

 (used for abnormal heart rhythms)

 —

 Alprazolam [increases digoxin concentrations](https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/021434s022lbl.pdf), especially when given to patients >65 years of age, and can cause toxicity.

 * Examples of commonly prescribed strong CYP3A4 inhibitors. See a healthcare provider online to learn what treatment for anxiety can help in your unique situation. [ * Book an appointment ](https://join.medvidi.com/signup) 
## Major Xanax Interactions in Detail 
 Some interactions are more serious than others and we’ll discuss them in more detail.

 
### Opioids
 Opioids are a drug class that can have life-threatening consequences with Xanax (alprazolam) and should, ideally, not be combined. Opioids are used to manage severe pain, but should only be prescribed when all other treatment options are exhausted. The interaction is so dangerous that the FDA has included a boxed warning, the most serious type of alert, [in the Xanax package insert](https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/021434s022lbl.pdf): “*Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death.”*

 "One of the major risks of alprazolam use is respiratory depression. While this risk is low when used alone at therapeutic doses, it increases significantly when combined with other respiratory depressants — such as opioids or alcohol — and can become life-threatening. " * [**Dr. Henry Bradford, MD**](/team/dr-henry-bradford/) Medical provider at MEDvidi 
### Other Drug Classes That Cause Drowsiness
 Any CNS depressant, listed in the above table, can be problematic when used with alprazolam, because they increase the risk of drowsiness, dizziness, being off-balance, and difficulty concentrating; the consequences of the increased side effects can be accidents, falls, or harmful decision-making. Therefore, healthcare professionals may avoid the combination or adjust the doses to compensate.

 
### Antidepressants
 Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed first-line for depression and anxiety disorders and might interact with alprazolam for various reasons. [Fluvoxamine, paroxetine](https://www.ncbi.nlm.nih.gov/books/NBK557698/), and [fluoxetine](https://pubmed.ncbi.nlm.nih.gov/11876575/) are CYP3A4 inhibitors, interfering with Xanax’s breakdown and will increase the side effects. Another SSRI, [sertraline](https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/018276s059lbl.pdf), when used in combination with alprazolam, is generally safe, according to the FDA. Although [citalopram](https://pubmed.ncbi.nlm.nih.gov/11876575/) and [escitalopram](https://www.drugs.com/interactions-check.php?drug_list=1013-0,133-54) are unlikely to interfere with alprazolam metabolism, if they cause side effects like drowsiness, this can amplify the side effects of alprazolam.

The tricyclic antidepressants [amitriptyline](https://www.ncbi.nlm.nih.gov/books/NBK557698/), imipramine, and desipramine are CYP3A4 inhibitors, but also CNS depressants; two reasons that they can exacerbate Xanax side effects.

 
### Antifungal Medications
 The azole antifungals, for example, itraconazole, ketoconazole, and voriconazole, are potent[ CYP3A4 inhibitors](https://drug-interactions.medicine.iu.edu/MainTable.aspx) and should be avoided when taking alprazolam. They prevent Xanax from being broken down, so its concentration builds up in the bloodstream, causing more side effects.

 Ketoconazole increases the levels [3.98-fold](https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/018276s059lbl.pdf), and itraconazole increases them [2.66-fold](https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/018276s059lbl.pdf) and should never be combined with Xanax.

 Other azoles, such as isavuconazole, posaconazole, and fluconazole, should also be used cautiously.

 
### Antibiotics
 Macrolide antibiotics, such as erythromycin, clarithromycin, and azithromycin, are often prescribed for respiratory tract and skin infections, and some sexually transmitted infections (STIs). Clarithromycin and erythromycin are [strong and moderate CYP3A4 inhibitors](https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/018276s059lbl.pdf) and should not be used with alprazolam. However, [azithromycin](https://www.ncbi.nlm.nih.gov/books/NBK551495/) is a safe alternative.

 [Ciprofloxacin](https://www.ncbi.nlm.nih.gov/books/NBK535454/) is an antibiotic used to treat a wide range of infections, including those of the urinary tract, gastrointestinal tract, skin, bones, joints, respiratory system, and sexually transmitted infections (STIs). It is also a CYP3A4 inhibitor and should be used with caution when taken with alprazolam; other antibiotics provide the same antibacterial coverage.

 
### Anticonvulsants
 [Carbamazepine](https://www.ncbi.nlm.nih.gov/books/NBK482455/) is a useful medication used for the treatment of epilepsy, bipolar disorder, and facial nerve pain. Unfortunately, it can increase alprazolam breakdown, making Xanax less effective for anxiety. If prescribed together, the doctor may need to increase the dose of alprazolam.

 
### Cimetidine
 Cimetidine is another medication that significantly [increases Xanax levels](https://www.ncbi.nlm.nih.gov/books/NBK544255/) because it is a CYP3A4 inhibitor; it treats stomach ulcers and heartburn because it decreases gastric acid, and some skin conditions due to its effect on the immune system.

 
### Ritonavir
 Ritonavir is an antiretroviral (ARV) medication that lowers the levels of HIV in the bloodstream, and it is sometimes combined with other ARVs in a single tablet. It is also an ingredient in a COVID-19 medication called Paxlovid. Although it is a [strong CYP3A4 inhibitor](https://drug-interactions.medicine.iu.edu/MainTable.aspx), increasing the levels and side effects of alprazolam, the effect stabilizes after 14 days. Doctors will work around this by using[ lower doses of Xanax during the first 2 weeks](https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/018276s059lbl.pdf) of ritonavir treatment.

 
## Other Notable Interactions
 You also need to be careful when taking Xanax with over-the-counter (OTC) medication and certain supplements.

 
### Melatonin
 People who have trouble sleeping often use this over-the-counter (OTC) medication; it may increase the risk of dizziness, drowsiness, confusion, and difficulty concentrating if used with alprazolam.

 
### Herbal Supplements
 
- St. John’s wort: This herbal antidepressant [increases the breakdown](https://pmc.ncbi.nlm.nih.gov/articles/PMC4463967/) of alprazolam and decreases its effects.- Kava-kava: Traditionally used to ease anxiety, stress, and insomnia, so that it will increase alprazolam side effects; in addition, [it inhibits its breakdown](https://pmc.ncbi.nlm.nih.gov/articles/PMC5421430/), increasing the alprazolam blood concentration.- Goldenseal: A herb used to treat infections (antibacterial and antifungal), high blood pressure, cholesterol, and diabetes. It [contains berberine](https://pmc.ncbi.nlm.nih.gov/articles/PMC4463967/), which might block the breakdown of alprazolam at higher than recommended doses and should be used with caution.- Kratom: Used to increase energy and [calmness, decrease pain, and give an opioid-like effect](https://nida.nih.gov/research-topics/kratom). Sometimes, it can cause [serious side effects](https://nida.nih.gov/research-topics/kratom#safe) similar to alprazolam, like confusion, dizziness, and slow breathing; it makes sense that if used together, there could be life-threatening consequences.- Cannabis: Is used off-label for the treatment of anxiety and sleep disorders; in combination with alprazolam, there is an increased risk of CNS depression and side effects.- [Ginkgo biloba extract and echinacea](https://pmc.ncbi.nlm.nih.gov/articles/PMC4463967/) at recommended doses don’t seriously affect the CYP3A4 enzyme and are usually safe.- [Milk thistle and garlic](https://pmc.ncbi.nlm.nih.gov/articles/PMC4463967/) do not cause any significant drug interactions with alprazolam.
 
### Vitamins and Minerals
 Common vitamins and minerals found in supplements, such as vitamins B, C, and D, calcium, magnesium, and iron, do not affect the enzyme that metabolizes Xanax and do not have effects similar to benzodiazepines; therefore, they are generally safe to take together. However, talk to your healthcare provider to get individualized advice.

 
## Alprazolam Dietary and Food Interactions
 Alprazolam interactions don’t end with prescription, herbal, or over-the-counter medications; in addition, there are foods to avoid:

 
 - Grapefruit and grapefruit juice: They increase side effects by preventing the breakdown of alprazolam. - Fatty foods: Some sources suggest that taking alprazolam with [high-fat meals increases](https://go.drugbank.com/drugs/DB00404) absorption and concentration, but the package insert states that it can be taken with or without food. - Alcohol: People who drink alcohol [while taking alprazolam](https://medvidi.com/blog/xanax-and-alcohol) might experience more dizziness, drowsiness, and confusion. - Caffeine: Coffee and energy drinks containing caffeine are stimulants and reduce alprazolam’s calming effects. 
 Importantly, many more interactions might not have been covered. That is why it is vital to check with your doctor, pharmacist, and read the patient package insert.

 
## Side Effects of Alprazolam
 Because many of the interactions cause alprazolam’s side effects to become worse or dangerous, it is important to recognize them.

 Common [side effects](https://medvidi.com/blog/side-effects-of-xanax) include:

 
 - Tiredness - Dizziness - Forgetfulness - Poor focus - Constipation or diarrhea - Nausea and vomiting - Sweating - Headache - Weak muscles - Loss of interest in sex - Worsening depression 
 Serious side effects:

 
 - Respiratory depression, which presents as shallow and slow breathing - Low blood pressure  - Excessive sleepiness causing accidents or work errors - Poor balance resulting in falls and injuries - Confusion 
 Get ongoing care for anxiety online; have an initial consultation within 24 hours. [ * Book an appointment ](https://join.medvidi.com/signup) 
## Health Conditions Affecting Alprazolam Use and Dosage
 Believe it or not, there are also health conditions that can affect alprazolam use and blood levels.

Doctors will be [cautious when](https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/021434s022lbl.pdf) using alprazolam in:

- Patients with depression or bipolar disorder: Alprazolam may cause worsening depression or manic episodes.- Late pregnancy: The newborn may experience drowsiness, breathing or feeding problems, and withdrawal symptoms.- Patients with breathing problems.- People with a history of addiction or substance use disorder.
Specific patient populations and medical conditions can also affect the blood levels of alprazolam and how long it’s active in the body. [Situations where it is active for longer](https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/021434s022lbl.pdf) include:

- Patients with obesity- Elderly patients- Patients with alcoholic liver disease- Asian patients, when compared to caucasian patients
Whereas the alprazolam concentration[ in people who smoke is half](https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/021434s022lbl.pdf) that of people who don’t.

 
## How to Take Xanax Safely
 There are many things to consider when wanting to take Xanax or alprazolam safely. These include circumstances where you should never take Xanax (contraindications) and others needing dose adjustments and close monitoring. 

 Firstly, before prescribing alprazolam, your doctor will take a detailed physical and mental health history to make sure it is an appropriate medication for you.

 Alprazolam [contraindications](https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/021434s022lbl.pdf) include people who:

 
 - Have had an allergic reaction to alprazolam or other benzodiazepines - Are using the strong CYT3A4 inhibitors that you’ve learned about  
 As you can see, it is vital to tell your doctor about all the medications you are taking, and read the package insert carefully before starting Xanax.

 Secondly, remember it is an FDA-controlled substance and use it as prescribed; the boxed warning alerts patients and doctors about Xanax misuse, physical dependence, and the potential for drug abuse.

 Finally, [withdrawal symptoms](https://medvidi.com/blog/xanax-withdrawal) can happen if you stop alprazolam suddenly; it is vital to taper it down slowly and should ask a doctor for advice on how to do this.

 You now understand more about Xanax (alprazolam), and either your questions have been answered, or you are thinking about consulting a healthcare provider.

 
## When to Contact a Healthcare Provider
 There are a few situations where you should consider contacting a doctor:

 
 - You suspect you may have anxiety and would like to chat to a professional. - You have an anxiety disorder, but your medication is not working, and you’d like to discuss other options. A healthcare provider will tell if [a script for alprazolam](https://medvidi.com/blog/how-to-get-xanax-prescribed-online) is appropriate, or whether benzodiazepines may not be right for you. - You currently have a script for alprazolam, but it is causing terrible side effects, or doesn’t feel like it’s working at all. 
 Luckily, [online anxiety treatment](https://medvidi.com/services/anxiety-disorder-treatment/) at MEDvidi is available, so take that next step today if you need advice from a licensed medical professional.

 
## FAQs About Alprazolam Interactions 
 
### What pain reliever can I take with Xanax? 
 Pain relievers that are safe to take with Xanax are [ibuprofen](https://www.drugs.com/interactions-check.php?drug_list=1310-0,133-54) and [acetaminophen](https://www.drugs.com/interactions-check.php?drug_list=11-12,133-54). Talk to your healthcare provider for individualized advice.

 
### Can I take ibuprofen (Advil) with Xanax? 
 Yes, it is safe to take ibuprofen and Xanax together as there are [no drug interactions](https://www.drugs.com/interactions-check.php?drug_list=1310-0,133-54).

 
### Can you take Tylenol with Xanax? 
 Yes, it is safe to take Tylenol and Xanax together as there are [no drug interactions](https://www.drugs.com/interactions-check.php?drug_list=11-12,133-54).

 
### Can I take Nyquil while taking alprazolam? 
 Nyquil contains medication that suppresses cough and makes you sleepy; using it in combination with alprazolam increases side effects like dizziness, drowsiness, confusion, and difficulty concentrating and [is not recommended](https://www.drugs.com/interactions-check.php?drug_list=55-17410,133-54).

 
### Can you take Benadryl with Xanax? 
 [It is not recommended](https://www.drugs.com/interactions-check.php?drug_list=896-1617,133-54); using Benadryl with Xanax increases the risk of drowsiness, dizziness, and difficulty concentrating.

 
### Can I take Viagra while on Xanax? 
 While there is [no significant interaction](https://www.drugs.com/interactions-check.php?drug_list=2061-1352,133-54) between Xanax and Viagra, they might influence the effects of each other. Talk to your healthcare provider for individualized advice.

 
### What happens if I take Xanax with Paxlovid? 
 You should avoid Xanax with Paxlovid. Paxlovid contains ritonavir that can increase the levels of alprazolam, with [life-threatening effects](https://www.drugs.com/interactions-check.php?drug_list=4326-19915,133-54) such as excessive drowsiness and breathing difficulties.

 
### Can I take Zyrtec with Xanax? 
 [It is not recommended](https://www.drugs.com/interactions-check.php?drug_list=133-54,569-286); using Zyrtec with Xanax increases the risk of drowsiness, dizziness, and difficulty concentrating.

 
### Can you take cyclobenzaprine and Xanax? 
 [It is not recommended](https://www.drugs.com/interactions-check.php?drug_list=758-0,133-54); using cyclobenzaprine with Xanax increases the risk of drowsiness, dizziness, and difficulty concentrating.

 
### Can you take Xanax XR with regular Xanax? 
 No, it’s better to avoid this due to the potential for increased side effects, unless your doctor has recommended it.

 
### Can you take Xanax with Wellbutrin? 
 Talk to your doctor before using Xanax and Wellbutrin together, as there is a [risk of seizures](https://www.drugs.com/interactions-check.php?drug_list=440-2469,133-54) in certain situations.

 
### Can you take Xanax and Zoloft? 
 Yes, you can take Xanax and Zoloft together if prescribed by the same doctor; there is [no significant interaction](https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/021434s022lbl.pdf). Talk to your healthcare provider for individualized advice.

 
### Can Xanax be taken with promethazine? 
 [It is not recommended](https://www.drugs.com/interactions-check.php?drug_list=1949-4360,133-54); using Xanax with promethazine increases the risk of drowsiness, dizziness, and difficulty concentrating.

 
### Can you take buspirone and Xanax together? 
 [It is not recommended](https://www.drugs.com/interactions-check.php?drug_list=441-0,133-54); using buspirone with Xanax increases the risk of drowsiness, dizziness, and difficulty concentrating.

 
### Can I take Xanax with gabapentin? 
 Gabapentin is an antiepileptic, also used for nerve pain and anxiety off-label, and can make you sleepy; using it in combination with alprazolam increases side effects such as dizziness, drowsiness, confusion, and difficulty concentrating and [is not recommended](https://www.drugs.com/interactions-check.php?drug_list=1147-0,133-54).