Xanax interactions: Alcohol, medications, and other factors

Before you start treatment with Xanax, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Xanax interacts with supplements, herbs, or vitamins, see the “Xanax and other interactions” section below.)

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

Here’s a table of drugs that can interact with Xanax. Keep in mind that this table doesn’t include all drugs that may interact with Xanax. Some of these interactions are described in detail just below in “Drug interactions in depth.”

*Xanax has a boxed warning about the risk of serious side effects if taken with opioids. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more about this interaction, see the boxed warnings at the start of this article.

† CYP3A is an enzyme (type of protein) in your body that helps break down Xanax. Your doctor likely will not prescribe Xanax with drugs that are strong CYP3A inhibitors. This is a Xanax contraindication. To learn more about this interaction, see the section below called “When to avoid Xanax.”

‡ To learn more about this interaction, see the “Drug interactions in depth” section below.

In some cases, factors or conditions could prevent your doctor from prescribing Xanax due to the risk of harm. These are known as contraindications. The contraindications of Xanax include:

Taking drugs that are strong CYP3A inhibitors

Doctors typically will not prescribe Xanax in combination with drugs that are strong cytochrome P450 3A (CYP3A) inhibitors.

CYP3A is an enzyme (type of protein) in your body that helps break down Xanax. Drugs that are strong CYP3A inhibitors slow the action of this enzyme. Taking Xanax with a strong CYP3A inhibitor can make Xanax build up in your body. This can raise your risk of serious side effects* of Xanax, such as severe sleepiness or breathing problems.

Below are a few examples of drugs that are strong CYP3A inhibitors that can interact with Xanax:

• clarithromycin
• itraconazole (Sporanox)
• ketoconazole
• nelfinavir (Viracept)
• posaconazole (Noxafil)
• voriconazole (Vfend)

Before you start treatment with Xanax, it’s important to tell your doctor if you take any of the medications listed above. Also tell your doctor what other medications you take. They can check if it’s safe to take Xanax with your other medications.

Note that the HIV drug ritonavir (Norvir) is also a strong CYP3A inhibitor, but it is not contraindicated with Xanax. Your doctor may prescribe Xanax with ritonavir, but in this case, they may prescribe a Xanax dosage that’s lower than usual.

* For details about Xanax’s side effects, see this article.

Having had an allergic reaction to Xanax or other benzodiazepines

If you have had an allergic reaction to Xanax or any of its ingredients, or to other benzodiazepine drugs such as diazepam (Valium), your doctor will likely not prescribe Xanax. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Xanax, it’s important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe Xanax.

Your doctor will likely recommend that you not drink alcohol while taking Xanax. They’ll also usually advise you not to take any prescription or over-the-counter drugs that contain alcohol during Xanax treatment.

Consuming alcohol and taking Xanax may cause serious side effects, including:

• respiratory depression (slow, shallow breathing)
• severe sleepiness
• decreased awareness
• coma

The combination of alcohol and Xanax may also, in some cases, lead to death. If you have concerns about avoiding alcohol while you’re taking Xanax, talk with your doctor before starting treatment.

Here’s a closer look at certain drug interactions of Xanax.

Drugs that are mild or moderate CYP3A inhibitors

Xanax can interact with drugs that are mild or moderate cytochrome P450 3A (CYP3A) inhibitors.

CYP3A is an enzyme (type of protein) in your body that helps break down Xanax. Drugs that are mild or moderate CYP3A inhibitors slow the action of this enzyme.

Interaction result: Taking Xanax with a mild or moderate CYP3A inhibitor can raise your risk of Xanax side effects,* such as sleepiness or breathing problems.

Interaction explained: Mild or moderate CYP3A inhibitors slow the breakdown of Xanax, so they can make Xanax build up in your body. Having a higher level of Xanax in your body is more likely to cause side effects.

Examples of drugs that are mild or moderate CYP3A inhibitors: Here are some mild or moderate CYP3A inhibitors that may interact with Xanax:

• cimetidine (Tagamet HB)
• diltiazem (Cardizem CD, others)
• erythromycin (Ery-Tab, others)
• fluconazole (Diflucan)
• fluvoxamine (Luvox)
• nefazodone
• verapamil (Verelan)

Steps you or your doctor may take: Your doctor will usually avoid prescribing Xanax with drugs that are mild or moderate CYP3A inhibitors. If you do take Xanax with one of these drugs, your doctor may prescribe a dosage of Xanax that’s lower than usual. Don’t take a higher dosage of either drug than your doctor prescribes.

Talk with your doctor right away if you become very sleepy or have slow, shallow breathing while taking Xanax with one of these drugs.

* For details about Xanax’s side effects, see this article.

Drugs that are CYP3A inducers

Xanax can interact with drugs that are cytochrome P450 3A (CYP3A) inducers.

CYP3A is an enzyme (type of protein) in your body that helps break down Xanax. Drugs that are CYP3A inducers speed up the action of this enzyme.

Interaction result: Taking Xanax with a CYP3A inducer can make Xanax less effective.

Interaction explained: CYP3A inducers speed up the breakdown of Xanax, so they can lower the amount of Xanax in your body. Having a lower level of Xanax in your body can make the drug less effective.

Examples of drugs that are CYP3A inducers: Here are some CYP3A inducers that may interact with Xanax:

• carbamazepine (Tegretol, others)
• phenytoin (Dilantin)
• rifampin (Rifadin, Rimactane)

Steps you or your doctor may take: Your doctor will usually avoid prescribing Xanax with drugs that are CYP3A inducers. If you do take Xanax with one of these drugs, your doctor may prescribe a dosage of Xanax that’s higher than usual.

CNS depressants

Xanax can interact with central nervous system (CNS) depressants, which are drugs that can slow activity in your brain and spinal cord. Several types of drugs are CNS depressants, including benzodiazepines such as Xanax.

Interaction result: Taking Xanax with other CNS depressant drugs can raise your risk of severe sleepiness and breathing problems.

Interaction explained: Your CNS controls most of your bodily functions, including voluntary functions such as moving and speaking, and involuntary functions such as breathing. By slowing activity in your CNS, CNS depressants can cause side effects such as sleepiness. But taking more than one CNS depressant can slow CNS activity even more, which can cause severe sleepiness or sedation and slowed breathing.

Examples of CNS depressant drugs: Here are some CNS depressants that may interact with Xanax:

• certain antidepressants, such as amitriptyline, mirtazapine (Remeron), and trazodone
• certain antipsychotics, such as haloperidol (Haldol) and risperidone (Risperdal)
• certain seizure medications, such as gabapentin (Neurontin) and topiramate (Topamax)
• opioids* such as morphine (MS Contin) and fentanyl (Fentora, others)
• certain muscle relaxants, such as carisoprodol (Soma) and cyclobenzaprine (Amrix)
• sleeping pills, such as zaleplon (Sonata) and zolpidem (Ambien)
• sedating antihistamines, such as chlorpheniramine and promethazine

Steps you or your doctor may take: If your doctor prescribes Xanax with another CNS depressant, they may prescribe a dosage of Xanax that’s lower than usual. Don’t take a higher dosage of either drug than your doctor prescribes.

Talk with your doctor right away if you become very sleepy or have slow, shallow breathing while taking Xanax with another CNS depressant.

* Xanax has a boxed warning about the risk of serious side effects if taken with opioids. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more about this interaction, see the boxed warnings at the start of this article.

Xanax may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Xanax.

Xanax interactions with supplements

Before you start treatment with Xanax, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

Doctors will likely recommend that you avoid using sleep aid supplements with Xanax. Examples include valerian and melatonin. Taking these supplements with Xanax may cause severe sleepiness.

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

Xanax interactions with herbs

Doctors will typically recommend you avoid taking St. John’s wort with Xanax. St. John’s wort is an herbal supplement that may be used to help treat depression and other conditions.

St. John’s wort may speed up the activity of an enzyme in your body called cytochrome P450 3A4 (CYP3A4). This enzyme helps break down Xanax.

By speeding up this enzyme, St. John’s wort can cause Xanax to break down more quickly. And this may lead to a low level of Xanax in your system. If the level of Xanax in your system is too low, the drug may not work to treat anxiety.

Your doctor may be able to suggest a treatment option other than St. John’s wort.

Xanax and vitamins

There are no specific reports of vitamins interacting with Xanax. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Xanax.

Xanax interactions with food

Grapefruit and grapefruit juice can interact with Xanax. Specifically, grapefruit products can stop your body from breaking down Xanax. This raises the level of Xanax in your body, which increases your risk of side effects from Xanax.* Due to this risk, your doctor may recommend not consuming grapefruit and grapefruit juice while taking the drug.

* For details about Xanax’s side effects, see this article.

Xanax and vaccines

There aren’t any known interactions between Xanax and vaccines. Talk with your doctor or pharmacist to see whether you’re due for any vaccines.

Xanax and lab tests

Xanax isn’t known to interact with any lab tests. If you have concerns about this medication interacting with lab tests, talk with your doctor.

XANAX INTERACTION WITH CANNABIS OR CBD

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

Using cannabis with Xanax can increase the level of Xanax in your body. This can raise your risk of Xanax side effects, especially sleepiness, since cannabis can also cause sleepiness.

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 U.S. states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Xanax. Before you take this drug, be sure to talk with your doctor about your health history. Xanax may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Xanax include:

• Older age: If you’re age 65 years or older, you may have a higher risk of side effects with Xanax. Due to this risk, your doctor may prescribe a dosage of Xanax that’s lower than usual.
• Depression or bipolar disorder: Xanax can worsen depression and bipolar disorder. If you have a history of depression or bipolar disorder, talk with your doctor about whether Xanax is right for you.
• Breathing problems: If you have breathing problems such as chronic obstructive pulmonary disease (COPD) or sleep apnea, Xanax could worsen your breathing. Talk with your doctor about whether Xanax is right for you.
• Liver problems: If you have liver problems, Xanax can build up in your body. This can raise your risk of side effects from Xanax. Due to this risk, your doctor may prescribe a dosage of Xanax that’s lower than usual.
• Allergic reaction: If you’ve had an allergic reaction to Xanax, any of its ingredients, or other benzodiazepines, your doctor will likely not prescribe Xanax. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.
• Breastfeeding: Your doctor will likely recommend that you don’t breastfeed while taking Xanax. Xanax may pass into breast milk and cause side effects such as sleepiness, feeding problems, and withdrawal symptoms in a child who is breastfed. If you’re breastfeeding or planning to, talk with your doctor before using Xanax. They can talk with you about treatment options and ways to feed your child.
• Pregnancy: Xanax has not been found to cause congenital anomalies (commonly known as birth defects) when used in early pregnancy. But it may cause side effects in the baby if used in later pregnancy. If you’re pregnant or planning to become pregnant, tell your doctor before starting Xanax. They can advise you on the right treatment plan for you.
• Driving or operating machinery: Xanax can reduce your ability to safely drive or operate machinery. Talk with your doctor about this.
• Risks of misuse, addiction, dependence, withdrawal, and use with opioids: Xanax has boxed warnings about the risks of misuse, addiction, dependence, withdrawal, and use with opioids. A boxed warning is a serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous. For details, see the boxed warnings at the top of this article.

You can take certain steps to help prevent interactions with Xanax. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Xanax label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Xanax doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Xanax by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Xanax. These resources might help:

• Overview of Xanax: For a general overview of Xanax, you can see this article.
• Side effects: If you’re interested in the side effects of Xanax, see this article. Another option is to refer to the Xanax prescribing information.
• Dosage specifics: To learn about the dosage of Xanax, see this article.
• Drug comparison: For information about how Xanax compares with Valium, read this article. And to learn about how Xanax compares with Ativan, see this article.
• Cost: If you’d like to learn about Xanax and cost, see this article.
• Facts about your condition: To learn more about your condition, see our anxiety hub and mental health hub.

Disclaimer: Medical News Today 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.