Xanax (alprazolam) is a prescription drug that’s used to treat certain types of anxiety disorders. It comes as a tablet that you swallow. This drug can interact with alcohol, other medications, and some supplements. For example, Xanax can interact with opioids and certain antibiotics.
Xanax is prescribed to adults to treat:
An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.
Keep reading to learn about Xanax’s possible interactions. And for more information about Xanax, including details about its uses, see this article.
Xanax is also available in another form called Xanax XR.
Xanax XR is an extended-release tablet that’s used to treat panic disorder only. Extended release means the medication is released slowly over time. Xanax is an immediate-release tablet, which means all of the drug is released at one time when the tablet dissolves.
Xanax and Xanax XR should have the same interactions. But because Xanax XR is released slowly over time, the drug stays in your body longer than Xanax. Because of this, side effects related to Xanax XR’s interactions may last longer than those from Xanax.
This article will focus on Xanax’s interactions. To learn more about Xanax XR, talk with your doctor or see the drug’s prescribing information.
Certain health conditions or other factors could raise your risk of harm if you take Xanax. In such cases, your doctor may not prescribe Xanax for you. These are known as contraindications. The list below includes the contraindications of Xanax.
If you take certain antifungals or antibiotics. Certain antifungals or antibiotics can prevent your body from breaking down Xanax. This can cause the drug to build up in your body, which may raise your risk for side effects from Xanax.
Examples of drugs that can affect the way your body breaks down Xanax include:
- certain antifungal drugs such as ketoconazole and itraconazole (Sporanox, Tolsura)
- certain antibiotics such as clarithromycin and erythromycin
Due to this risk, doctors typically will not prescribe Xanax if you’re taking antifungals or antibiotics that may affect how your body breaks down Xanax. If you’re taking any of these medications, let your doctor know before you start taking Xanax. They’ll likely wait until you finish your antibiotic or antifungal treatment before prescribing Xanax.
If you’ve had an allergic reaction. If you’ve had an allergic reaction to Xanax or any of its ingredients, your doctor likely won’t prescribe Xanax. 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.
Before you start taking Xanax, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Xanax is safe for you to take.
Yes, Xanax interacts with alcohol. Drinking alcohol during your Xanax treatment can cause serious side effects, such as central nervous system (CNS) depression. The CNS consists of your brain and spinal cord. It helps regulate breathing, thinking, movement, and other functions.
Combining alcohol and Xanax can raise your risk of symptoms from CNS depression. Examples of these symptoms include:
- excessive sleepiness
- coordination and balance problems
- trouble concentrating
- slowed reaction time
- memory loss
- slowed breathing
In rare cases, combining alcohol and Xanax can lead to coma or can be fatal.
Drinking alcohol during your Xanax treatment can also increase your risk of Xanax misuse.* (Misuse means taking or using a drug differently from how your doctor prescribed it.) This could result in overdose and may sometimes be life threatening.
Due to these risks, your doctor will likely recommend that you do not drink alcohol while you’re taking Xanax.
If you drink alcohol and have questions or concerns about avoiding alcohol with Xanax, talk with your doctor.
* Xanax has a
Before you start taking Xanax, 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 Xanax interacts with supplements, herbs, and vitamins, see the “Are there other interactions with Xanax?” section below.)
If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.
The table below lists drugs that may interact with Xanax. Keep in mind that this table does not include all drugs that may interact with Xanax. For more information about some of these interactions, see the “Drug interactions explained” section below.
|Drug group or drug name||Drug examples||What can happen|
• morphine (MS Contin)
• oxycodone (OxyContin, Xtampza ER)
• buprenorphine/naloxone (Suboxone)
• tramadol (ConZip)
|can increase the risk for side effects from Xanax and opioids|
|certain antifungals or antibiotics||• ketoconazole|
• itraconazole (Sporanox, Tolsura)
• erythromycin (Ery-Tab)
|can raise the risk for side effects from Xanax|
|CNS depressants||• phenobarbital|
• promethazine (Phenergan)
• zolpidem (Ambien)
• tizanidine (Zanaflex)
|can increase the risk for side effects from Xanax and CNS depressants|
|certain seizure drugs||• carbamazepine (Tegretol)|
• phenytoin (Dilantin)
|can make Xanax less effective|
|ritonavir (Norvir)||—||can temporarily raise the risk for side effects from Xanax|
|digoxin (Lanoxin)||—||can raise the risk for side effects from digoxin|
|buspirone||—||can increase the risk for side effects from buspirone and Xanax|
|hydroxyzine (Vistaril)||—||can increase the risk for side effects from hydroxyzine and Xanax|
|quetiapine (Seroquel)||—||can increase the risk for side effects from Seroquel and Xanax|
|trazodone||—||can increase the risk for side effects from Xanax and trazodone|
|gabapentin (Neurontin, Horizant, Gralise)||—||can increase the risk for side effects from gabapentin and Xanax|
|nefazodone||—||can raise the risk of side effects from Xanax|
|fluvoxamine||—||can increase the risk for side effects from Xanax|
|fluoxetine (Prozac)||—||can raise the risk of side effects from Xanax|
|birth control pills||• desogestrel/ethinyl estradiol (Apri)|
• ethinyl estradiol/norgestimate (Ortho Tri-Cyclen)
• drospirenone/ethinyl estradiol (Yaz, Yasmin)
|can increase the risk for side effects from Xanax|
|other benzodiazepines||• clonazepam (Klonopin)|
• diazepam (Valium)
• lorazepam (Ativan)
|can raise the risk for side effects from Xanax and the other benzodiazepines|
Learn more about certain drug interactions that can occur with Xanax.
Interaction with opioids
Xanax can interact with opioids, which are prescription drugs typically used short term to relieve severe pain. Certain kinds of opioids are prescribed to treat opioid use disorder.
Examples of opioid medications:
- methadone (Methadose)
- hydrocodone (Hysingla ER)
- oxycodone (OxyContin, Xtampza ER)
- tramadol (ConZip)
- buprenorphine/naloxone (Suboxone)
What could happen
Both Xanax and opioids can cause central nervous system (CNS) depression.* With CNS depression, you can have serious side effects such as slowed breathing or extreme sleepiness. In rare cases, CNS depression can lead to coma or be fatal.
Taking Xanax with opioids can raise your risk for CNS depression.
* Xanax has a
What you can do
In most cases, your doctor will not prescribe opioids with Xanax unless other medications haven’t worked for your condition. If your doctor prescribes Xanax with an opioid, they’ll monitor you closely for signs of CNS depression during treatment. They’ll also prescribe Xanax at the lowest effective dosage and for the shortest length of time needed.
If you do take Xanax with an opioid, let your family or close friends know. If you experience symptoms of CNS depression, you or another person should call 911 or your local emergency number right away.
If you take an opioid with Xanax, your doctor may also recommend keeping naloxone (Narcan) nasal spray on hand. Narcan is used as an emergency treatment if an opioid overdose has happened or has possibly happened. Narcan works by reversing the effects of opioids, including CNS depression. Your doctor or pharmacist can tell you more about how to use Narcan.
Your doctor may prescribe Narcan, or in many cases you can get it at your local pharmacy without a prescription. To learn more about Narcan, talk with your doctor or pharmacist.
Interaction with trazodone
Trazodone causes drowsiness, so doctors may prescribe it for people with depression who have trouble sleeping.
In some cases, your doctor may prescribe trazodone with Xanax if you have anxiety and trouble sleeping.
What could happen
Both Xanax and alprazolam can cause sleepiness. Taking trazodone and Xanax together can increase your risk of excessive sleepiness. This is because both drugs can slow your brain activity.
What you can do
If your doctor prescribes Xanax with trazodone, they’ll likely monitor you for signs of excessive sleepiness.
Let your doctor know if you have trouble staying awake or waking up while you’re taking these drugs together. They’ll likely adjust the dosage of one or both medications to help relieve your side effects.
Xanax may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Xanax.
Does Xanax interact with supplements?
Before you start taking Xanax, talk with your doctor and pharmacist about any supplements, herbs, and vitamins 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.
Xanax interactions with herbs
Some people take certain supplements, such as valerian or melatonin, to help them sleep. Xanax can also cause drowsiness, so taking these supplements with Xanax can raise your risk of excessive sleepiness. Because of this, it’s important to check with your doctor or pharmacist before taking valerian or melatonin and Xanax together.
Gamma-aminobutyric acid (GABA) supplements are used by some people to reduce stress and anxiety and help with sleep. Because both can cause drowsiness, your doctor may recommend that you avoid taking Xanax and GABA supplements together.
Xanax can also interact with the herbal supplement St. John’s wort (which can be used to treat depression). Taking Xanax with this supplement may decrease the level of Xanax in your body. This can make the drug less effective.
If you take St. John’s wort, talk with your doctor before starting Xanax. They may suggest that you stop taking St. John’s wort during your Xanax treatment.
Xanax interactions with vitamins
There are currently no reports of Xanax interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.
For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Xanax.
Does Xanax interact with food?
Consuming grapefruit or grapefruit juice while taking Xanax can increase the level of Xanax in your body. This could raise your risk of side effects from Xanax. Due to this risk, your doctor will likely recommend avoiding grapefruit or grapefruit juice during your Xanax treatment.
If you have questions about which foods are safe to consume with Xanax, talk with your doctor.
Does Xanax interact with vaccines?
Currently, there are no reports of vaccines interacting with Xanax. If you have concerns about getting vaccines during your Xanax treatment, talk with your doctor.
Does Xanax interact with lab tests?
There are no specific reports of Xanax interacting with lab tests. But it’s still important to tell your doctor that you’re taking Xanax before getting any lab tests.
Does Xanax interact with cannabis or CBD?
Cannabis (commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Xanax. Taking Xanax with cannabis can increase your risk of side effects from Xanax. Because of this, doctors typically recommend you avoid taking Xanax with cannabis.
Before you start treatment with Xanax, 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.
Certain medical conditions or other health factors may raise the risk of interactions with Xanax. Before taking Xanax, talk with your doctor about your health history. They’ll determine whether Xanax is right for you.
Health conditions or other factors that might interact with Xanax include:
Older age. If you’re age 65 years or older, your risk for side effects with Xanax may be higher. These side effects may include dizziness, sleepiness, and coordination problems, which may raise your risk of a fall. Due to these risks, your doctor will likely prescribe a lower dosage of Xanax for you.
Kidney problems. If you have kidney problems, your body may not be able to remove Xanax properly. This may cause the drug to build up in your body, which can raise your risk of side effects. If you have kidney problems, talk with your doctor before starting Xanax treatment. They may prescribe a lower dosage for you.
Liver problems. If you have liver problems, your body may not be able to break down Xanax properly. This can cause the drug to build up in your body, which could raise your risk for side effects. If you have liver problems, tell your doctor before taking Xanax. They may prescribe a lower dosage of Xanax for you.
Breathing problems. Xanax can cause slowed breathing. If you already have breathing problems, Xanax may worsen your condition. Before starting Xanax treatment, talk with your doctor if you have breathing problems. They can determine whether Xanax is right for you.
Pregnancy. It’s not known whether it’s safe to take Xanax during early pregnancy. But taking Xanax during the third trimester of pregnancy (29 to 40 weeks) or during labor and delivery may cause harm to a newborn.
A newborn may experience problems such as:
- withdrawal symptoms,* such as prolonged crying, irritability, and tremors
- slowed breathing
- excessive sleepiness
- feeding difficulties
- floppiness (limpness)
If you’re pregnant or planning to become pregnant, talk with your doctor before you start taking Xanax. They can discuss the risks and benefits of taking this medication during pregnancy.
If your doctor prescribes Xanax during pregnancy, they may recommend that you sign up for the pregnancy registry for mental health medications. This registry helps healthcare professionals learn about the safety of taking psychiatric drugs, such as Xanax, during pregnancy.
* Withdrawal symptoms are side effects that occur when you stop having a drug your body has become dependent on. With dependence, your body becomes reliant on a drug to function as usual.
Breastfeeding. It’s not safe to breastfeed while taking Xanax. Xanax passes into breast milk and may cause harm to a child who is breastfed, including:
- excessive sleepiness
- problems feeding
- low body weight
- withdrawal symptoms, such as irritability, crying, and problems sleeping
If you’re breastfeeding or planning to do so before starting Xanax treatment, talk with your doctor about your options.
Allergic reaction. If you’ve had an allergic reaction to Xanax or any of its ingredients, your doctor will likely not prescribe Xanax. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.
Bipolar disorder or depression. Benzodiazepines, including Xanax, may worsen depression. Xanax may also cause episodes of mania in people with bipolar disorder. In some cases, panic disorder (which Xanax is used to treat) is associated with depression.
Before taking Xanax, tell your doctor if you have depression or bipolar disorder or have had these conditions in the past. They’ll let you know whether Xanax is right for you.
If you have depression or bipolar disorder and take Xanax, your doctor will likely monitor you closely for signs of worsening depression and suicidal thoughts during your treatment.
Help is out there
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 Textline 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.
Find answers to some frequently asked questions about Xanax and possible interactions.
Can I take Zoloft and Xanax together?
Zoloft (sertraline) is a serotonin reuptake inhibitor (SSRI) used to treat depression, anxiety, and other mental health conditions. It’s important to note that fluoxetine (Prozac), another SSRI, interacts with Xanax.
Taking Prozac with Xanax can cause Xanax to build up in your body. This could raise your risk of side effects from Xanax.
If you have questions about whether Xanax could interact with any medications you take, talk with your doctor.
Does Xanax interact with lisinopril?
No, there are no reported interactions between lisinopril and Xanax.
Other high blood pressure drugs called calcium channel blockers do interact with Xanax, however. Examples include diltiazem (Cardizem) and verapamil (Calan SR, Verelan).
Diltiazem and verapamil can prevent your body from breaking down Xanax as well as it should. This can cause Xanax to build up in your body, which may raise your risk for side effects.
Before starting Xanax treatment, talk with your doctor about the medications you take. They can tell you whether they’re safe to take with Xanax.
Is it safe to take Wellbutrin and Xanax together?
Yes. In most cases, it should be safe to take Wellbutrin (bupropion)* and Xanax together.
It’s important to note that taking Wellbutrin can increase your risk for seizures. And stopping benzodiazepines, including Xanax, suddenly also increases this risk. Because of this, you should not start taking Wellbutrin if you recently stopped taking Xanax suddenly. Xanax can also worsen depression, which Wellbutrin is used to treat.
Talk with your doctor if you have questions about taking Wellbutrin and Xanax together.
* Wellbutrin comes in two forms: Wellbutrin SR and Wellbutrin XL. Here, “Wellbutrin” applies to both forms.
Taking certain steps can help you avoid interactions with Xanax. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
- Whether you drink alcohol or use cannabis.
- Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a
- What to do if you start taking a new drug during your Xanax treatment.
It’s also important to understand Xanax’s
Taking Xanax exactly as prescribed can also help prevent interactions.
If you still have questions about Xanax and its possible interactions, talk with your doctor.
Questions you may want to ask your doctor include:
- Does my risk of interactions depend on my dosage of Xanax?
- Can I still take Xanax even if I have liver or kidney problems?
- Do I need to tell you if I start taking another medication or supplement during my Xanax treatment?
To learn more about Xanax, see these articles:
- Xanax (alprazolam)
- Xanax and Cost: What You Need to Know
- Dosage for Xanax: What You Need to Know
- Side Effects of Xanax: What You Need to Know
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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.