Xyrem (sodium oxybate) is a prescription drug that’s used to treat narcolepsy. This drug can interact with alcohol and other medications that cause drowsiness. For example, Xyrem can interact with zolpidem (Ambien).
Xyrem is used to treat the following conditions in adults and certain children with narcolepsy:
Xyrem comes as a liquid solution that you swallow. It contains the active ingredient sodium oxybate. (An active ingredient is what makes a drug work.)
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 Xyrem’s possible interactions. And for more information about Xyrem, including details about its uses, see this article.
Before you start taking Xyrem, 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 Xyrem interacts with supplements, herbs, and vitamins, see the “Are there other interactions with Xyrem?” 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 Xyrem. Keep in mind that this table does not include all drugs that may interact with Xyrem. 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 |
| sedatives* | • zolpidem (Ambien) • eszopiclone (Lunesta) • ramelteon (Rozerem) | can increase the risk of side effects from Xyrem and sedatives |
| opioids | • oxycodone (Oxaydo, OxyContin) • morphine (MS Contin) | can increase the risk of side effects from Xyrem and opioids |
| benzodiazepines | • alprazolam (Xanax) • oxazepam | can increase the risk of side effects from Xyrem and benzodiazepines |
| certain antidepressants | • mirtazapine (Remeron) • trazodone | can raise the risk of side effects from Xyrem and antidepressants |
| certain antipsychotics | • clozapine (Clozaril) • olanzapine (Zyprexa) | can increase the risk of side effects from Xyrem and antipsychotics |
| divalproex (Depakote, Depakote ER) | — | can increase the risk of side effects from Xyrem |
| muscle relaxers | • carisoprodol (Soma) • cyclobenzaprine (Flexeril) | can raise the risk of side effects from Xyrem and muscle relaxers |
* Sedatives may also be called sedative hypnotics or prescription sleep aids. To learn more about Xyrem’s interactions with these drugs, see the “When should I avoid Xyrem?” section below.
Certain health conditions or other factors could raise your risk of harm if you take Xyrem. In such cases, your doctor may not prescribe Xyrem for you. These are known as contraindications. The list below includes Xyrem contraindications.
If you have succinic semialdehyde dehydrogenase deficiency. If you have a rare genetic (inherited) condition called succinic semialdehyde dehydrogenase deficiency, taking Xyrem could increase your risk of side effects from the drug. This is because having this condition may cause Xyrem to build up in your body. Instead of prescribing Xyrem, your doctor can suggest other treatment options that are safer for you.
If you take sedatives or drink alcohol. Xyrem is a central nervous system (CNS) depressant.* This means it can slow certain brain signals that regulate vital body functions. This can lead to respiratory depression (slowed breathing). CNS depressants can also cause sedation (severe drowsiness).
You should not take Xyrem with other CNS depressants, such as alcohol and sedatives. (These are drugs that cause drowsiness, and include sleep aids such as zolpidem.) Combining these drugs or substances with Xyrem could lead to excessive sedation or dangerously slowed breathing. If you take sedatives or drink alcohol, your doctor will not prescribe Xyrem for you. They can suggest other treatment options that may be safer for you.
Before you start taking Xyrem, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Xyrem is safe for you to take.
* Xyrem has a
You should not drink alcohol during your Xyrem treatment.
Xyrem and alcohol are both central nervous system (CNS) depressants.* This means they both slow certain brain signals that help manage important body functions. As a result, the drug can cause respiratory depression (slowed breathing). Both Xyrem and alcohol can also cause sedation (severe drowsiness). Combining Xyrem and alcohol could further raise the risk of excessive sedation, respiratory depression, or both.
If you have concerns about avoiding alcohol during Xyrem treatment, talk with your doctor or pharmacist. They may suggest a different treatment option for you.
* Xyrem has a
Learn more about certain drug interactions that can occur with Xyrem.
Interaction with benzodiazepines
Xyrem can interact with benzodiazepines, which are prescribed to treat short-term anxiety and other symptoms of mental health conditions. In some cases, a benzodiazepine may be prescribed to help calm and prepare someone before they undergo a medical procedure.
Examples of benzodiazepines include:
- alprazolam (Xanax)
- clonazepam (Klonopin)
- diazepam (Valium)
- oxazepam
What could happen
Xyrem and benzodiazepines can both cause drowsiness. So taking these drugs together can raise your risk of this side effect. It can also make this side effect more severe.
What you can do
If you take Xyrem and need to take a benzodiazepine for a short period of time, your doctor may have you temporarily stop taking Xyrem. But if you take a benzodiazepine drug regularly, your doctor may prescribe a lower dosage of Xyrem for you. You should not take a higher dose of either medication than your doctor prescribes.
If you take Xyrem and a benzodiazepine together, tell your doctor right away if you develop severe drowsiness that’s different than what you usually experience with your condition.
If you have questions about taking Xyrem with benzodiazepines, talk with your doctor or pharmacist.
Interaction with opioids
Xyrem can interact with opioids. This is a group of drugs that include prescription pain medications as well as illegal drugs such as heroin.
Examples of opioids prescribed for severe pain include:
- fentanyl (Actiq, Fentora)
- hydrocodone (Hysingla ER)
- morphine (MS Contin)
- oxycodone (Oxaydo, OxyContin)
What could happen
Xyrem is a central nervous system (CNS) depressant.* This means it can slow certain brain signals that help manage important body functions. As a result, the drug can cause respiratory depression (slowed breathing). CNS depressants can also cause sedation (severe drowsiness).
Opioids are also CNS depressants. Combining these drugs could lead to excessive sedation or dangerously slowed breathing. These effects are the same as those that can occur during an opioid overdose, which can be life threatening.
* Xyrem has a
What you can do
If you take Xyrem and need to take an opioid pain medication for a short period of time, your doctor may have you temporarily stop taking Xyrem. But if you take an opioid drug regularly, your doctor may prescribe a lower dosage of Xyrem for you. You should not take a higher dose of either medication than your doctor prescribes.
If you take Xyrem and an opioid together, your doctor may suggest keeping naloxone (Narcan, RiVive, others) nasal (nose) spray on hand as a precaution. The drug is administered in an emergency to reverse the effects of opioids and restore regular breathing. Your doctor can prescribe naloxone, or you can request it at your local pharmacy without a prescription. For more information about naloxone, talk with your doctor or pharmacist.
If you have other questions about taking Xyrem with opioids, talk with your doctor or pharmacist.
Interaction with divalproex (Depakote, Depakote ER)
Xyrem can interact with divalproex (Depakote, Depakote ER). This drug is prescribed to treat epilepsy and certain mental health conditions such as bipolar disorder.
What could happen
Taking Xyrem with divalproex can raise the level of Xyrem in your body, which may increase your risk of side effects.
Xyrem is a central nervous system (CNS) depressant. These drugs can slow or impair certain brain functions, including those involved with thinking and memory. Taking divalproex with Xyrem may increase your risk of these side effects or make them worse. In studies, taking both Xyrem and divalproex made it more difficult for people to concentrate and remember things.
What you can do
If you take Xyrem and Depakote, your doctor may prescribe a dose of Xyrem that’s lower than usual. You should not take a higher dose of either medication than your doctor prescribes.
If you take Xyrem and Depakote together, tell your doctor right away if you develop new or worsened side effects of Xyrem.
If you have questions about taking Xyrem with Depakote, talk with your doctor or pharmacist.
Xyrem 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 Xyrem.
Does Xyrem interact with supplements?
Before you start taking Xyrem, 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.
Xyrem interactions with herbs
Xyrem may interact with an herb called St. John’ wort, which is used to ease symptoms of depression and other conditions. Taking Xyrem with St. John’s wort may lead to excessive sedation or worsened side effects from Xyrem.
In addition, Xyrem and some herbs may cause some of the same side effects, such as drowsiness. For example, some people take valerian or chamomile supplements to help them sleep. If you take these herbs during your Xyrem treatment, you may be more likely to experience drowsiness. Or this side effect could be more severe than it would be with Xyrem alone.
For this reason, it’s important to check with your doctor or pharmacist before taking any of these products with Xyrem.
Xyrem and vitamins
There are currently no reports of Xyrem 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 Xyrem.
Does Xyrem interact with food?
There are no reports of Xyrem interacting with specific foods. But it’s important that you wait at least 2 hours after eating before taking your first nightly dose of Xyrem. Taking Xyrem with food (or too soon after eating) could decrease the level of the drug in your body. This may make Xyrem less effective.
Does Xyrem interact with vaccines?
There are currently no reports of Xyrem interacting with vaccines. If you have questions about getting certain vaccines during your Xyrem treatment, talk with your doctor.
Does Xyrem interact with lab tests?
There are currently no reports of Xyrem interacting with lab tests. If you have questions about having certain lab tests during your treatment with Xyrem, talk with the healthcare professional ordering the test.
Does Xyrem interact with cannabis or CBD?Cannabis (commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Xyrem.
Xyrem and cannabis products are central nervous system (CNS) depressants. This means they both slow certain brain signals that help manage important body functions, such as breathing and thinking. As a result, both can cause respiratory depression (slowed breathing) and sedation (severe drowsiness). Combining Xyrem and cannabis products could further raise these risks.
Xyrem has a
boxed warning about the risk of CNS depression. A boxed warning is the most serious warning from the FDA. To learn more, see “Boxed warnings” at the top of this article.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 Xyrem. Before taking Xyrem, talk with your doctor about your health history. They’ll determine whether Xyrem is right for you.
Health conditions or other factors that might interact with Xyrem include:
Breathing problems. Xyrem may cause respiratory depression (slowed breathing) or trouble breathing. If you already have breathing problems, such as sleep apnea, taking Xyrem may worsen your condition.
Succinic semialdehyde dehydrogenase deficiency. Taking Xyrem is not safe for people with this condition. To learn more, see the “When should I avoid Xyrem?” section above.
Liver problems. If you have a liver problem, such as liver failure, the Xyrem level may build up in your body. This can raise your risk of side effects from the drug. Due to this risk, doctors will usually prescribe a lower dose of Xyrem for people with liver problems. To learn more, talk with your doctor.
Following a low salt diet. Before starting Xyrem treatment, tell your doctor if you follow a low salt diet. This may include a low salt diet for heart failure, high blood pressure, or kidney problems.
Xyrem contains a high amount of salt. You may want to consider tracking this amount of salt as part of your daily salt intake. To learn about the amount of salt in each dose of Xyrem, see the drug’s prescribing information.
Pregnancy. It’s not known whether Xyrem is safe to take during pregnancy. If you’re pregnant or planning a pregnancy, talk with your doctor before taking Xyrem.
Breastfeeding. It’s not known whether it’s safe to take Xyrem while breastfeeding. The drug passes into breast milk, but it isn’t known whether the drug may cause side effects in a child who is breastfed. If you’re breastfeeding or planning to breastfeed, talk with your doctor about your options.
Allergic reaction. If you’ve had an allergic reaction to Xyrem or any of its ingredients, your doctor will likely not prescribe Xyrem. 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.
Taking certain steps can help you avoid interactions with Xyrem. 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
medication list . - What to do if you start taking a new drug during your Xyrem treatment.
It’s also important to understand Xyrem’s
If you have trouble reading or understanding this information, your doctor or pharmacist can help.
Taking Xyrem exactly as prescribed can also help prevent interactions.
If you still have questions about Xyrem and its possible interactions, talk with your doctor.
Questions you may want to ask your doctor include:
- What is the ideal schedule for taking Xyrem and my other medications to help avoid interactions?
- Does taking a higher dose of Xyrem increase my risk of interactions with other drugs?
- Are there alternatives to Xyrem that don’t interact with alcohol?
To learn more about Xyrem, see these articles:
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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.