Xyrem interactions: Alcohol, medications, and other factors

In some cases, factors or conditions could prevent your doctor from prescribing Xyrem due to the risk of harm. These are known as contraindications. Keep reading to learn about Xyrem contraindications.

Having succinic semialdehyde dehydrogenase deficiency

Doctors typically will not prescribe Xyrem if you have succinic semialdehyde dehydrogenase deficiency. This is a rare genetic (inherited) condition that can prevent your body from breaking down Xyrem as well as it should. As a result, the Xyrem level could build up in your body and increase your risk of side effects from the drug.

If you have this condition, be sure to tell your doctor before taking Xyrem. They can recommend a different treatment option for you.

Taking sedative hypnotics

Doctors typically will not prescribe Xyrem with sedative hypnotics. These medications are used to treat sleep problems such as insomnia.

This is because both Xyrem and sedative hypnotics are central nervous system (CNS) depressants.* (The CNS includes your brain and spinal cord. It manages many functions in your body, including awareness, thinking, and movement.)

As CNS depressants, both Xyrem and sedative hypnotics can cause serious side effects. Examples include loss of consciousness and respiratory depression (shallow or slow breathing). Your risk of serious side effects is higher if you take Xyrem in combination with sedative hypnotics.

Below are a few examples of sedative hypnotics:

• zaleplon (Sonata)
• eszopiclone (Lunesta)
• zolpidem (Ambien, Ambien CR, Edluar)

Before starting Xyrem treatment, tell your doctor if you take a sedative hypnotic. They may have you stop the drug, or they may suggest a treatment other than Xyrem for your condition.

* Xyrem has a boxed warning about the risk of CNS depression. This is the most serious warning from the Food and Drug Administration (FDA). For more information, see “Boxed warnings” at the top of this article.

Consuming alcohol

Doctors typically will not prescribe Xyrem if you consume alcohol.

This is because Xyrem and alcohol are CNS depressants* that can cause serious side effects. These include loss of consciousness and respiratory depression. Your risk of these side effects is higher if you drink alcohol while taking Xyrem.

If you drink alcohol, talk with your doctor. They can suggest safe ways to stop consuming alcohol while taking Xyrem. Or they may recommend a different treatment for your condition.

* Xyrem has a boxed warning about the risk of CNS depression. This is the most serious warning from the Food and Drug Administration (FDA). For more information, see “Boxed warnings” at the top of this article.

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

Consuming alcohol is a contraindication for Xyrem. This means your doctor likely will not prescribe Xyrem if you drink alcohol due to the risk of harm.

For details about this, see the “When to avoid Xyrem” section above.

Before you start treatment with Xyrem, 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 Xyrem interacts with supplements, herbs, or vitamins, see the “Xyrem 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 Xyrem. Keep in mind that this table doesn’t include all drugs that may interact with Xyrem. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* For details, see the “When to avoid Xyrem” section above.

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

Benzodiazepines

Benzodiazepines can be prescribed to treat several conditions, including seizures and anxiety.

Interaction result. Taking Xyrem with a benzodiazepine can increase the risk of certain side effects from either drug. Specifically, taking these medications in combination can increase the risk of central nervous system (CNS) depression.*

Interaction explained. Xyrem and benzodiazepines are CNS depressants. This means both drugs can slow down the activity of your CNS, which includes your brain and spinal cord. The CNS manages many functions in your body, including awareness, thinking, and movement.

As CNS depressants, both Xyrem and benzodiazepines can cause serious side effects. Examples include loss of consciousness, fainting, low blood pressure, and respiratory depression (shallow or slow breathing). Your risk of these side effects is higher if you take Xyrem in combination with a benzodiazepine.

* Xyrem has a boxed warning about the risk of CNS depression. This is the most serious warning from the Food and Drug Administration (FDA). For more information, see “Boxed warnings” at the top of this article.

Examples of benzodiazepine drugs. Here are some benzodiazepines that may interact with Xyrem:

• clonazepam (Klonopin)
• alprazolam (Xanax)
• lorazepam (Ativan)

Steps you or your doctor may take. Doctors typically will not prescribe Xyrem with a benzodiazepine.

If you’re taking a benzodiazepine, your doctor will advise you about the risks of taking the drug with Xyrem. They may switch you from the benzodiazepine to a different treatment that doesn’t interact with Xyrem. Or they may prescribe a lower dosage of Xyrem or the benzodiazepine to help reduce the risk of side effects from either drug.

Opioids

Opioids are medications prescribed to ease pain.

Interaction result. Taking Xyrem with an opioid can increase the risk of CNS depression* from either drug.

Interaction explained. Both Xyrem and opioids are CNS depressants and can cause serious side effects. These include low blood pressure, respiratory depression, fainting, and loss of consciousness. Your risk of these side effects is higher if you take Xyrem in combination with an opioid.

Examples of opioid drugs. Here are some opioids that may interact with Xyrem:

• oxycodone (Oxycontin, Roxicodone, Xtampza ER, others)
• hydrocodone (Hysingla ER)
• morphine (Mitigo, MS Contin)

Steps you or your doctor may take. Doctors typically will not prescribe Xyrem with an opioid.

In some cases, doctors may prescribe short-term treatment with an opioid while you’re taking Xyrem. For example, they may prescribe an opioid to relieve pain after surgery. In this case, your doctor may temporarily stop treatment with Xyrem while you’re taking the opioid. They’ll do this to help reduce the risk of CNS depression.

* Xyrem has a boxed warning about the risk of CNS depression. This is the most serious warning from the Food and Drug Administration (FDA). For more information, see “Boxed warnings” at the top of this article.

Divalproex

Divalproex (Depakote, Depakote ER) is an antiepileptic drug. It’s prescribed to treat seizures and bipolar disorder.

Interaction result. Taking Xyrem with divalproex can increase the risk of side effects with Xyrem.

Interaction explained. Taking Xyrem with divalproex can raise the level of Xyrem in your body. And having a very high level of the drug in your system may increase your risk of side effects from Xyrem.

Steps you or your doctor may take. Before starting Xyrem, tell your doctor if you take divalproex. They can tell you whether it’s safe to take these medications in combination. If they tell you it’s safe, your doctor may prescribe a lower dosage of Xyrem than is typical. They’ll do this to lower your risk of side effects from the drug.

Xyrem 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 Xyrem.

Xyrem interactions with supplements

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

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

Xyrem interactions with herbs

Xyrem may interact with St. John’s wort. This is an herbal supplement used to ease symptoms of various conditions, including depression.

Taking Xyrem with this supplement may enhance the effects of Xyrem. This can lead to excessive sleepiness or a higher risk of side effects from the drug.

Because of this, it’s important to check with your doctor or pharmacist before taking any herbal supplements with Xyrem.

Xyrem and vitamins

There are no specific reports of vitamins interacting with Xyrem. 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 Xyrem.

Xyrem and food

No specific foods have been reported to interact with Xyrem.

However, keep in mind that you should not eat food at least 2 hours before taking Xyrem. Taking Xyrem with food can decrease the level of the drug in your body. This may make Xyrem less effective.

Xyrem and vaccines

There are no specific reports of vaccine interactions with Xyrem. If you’d like to learn more about getting specific vaccines during treatment with Xyrem, talk with your doctor.

Xyrem and lab tests

There are no specific reports of lab tests interacting with Xyrem. If you’d like to learn more about getting certain lab tests during treatment with Xyrem, talk with your doctor.

XYREM INTERACTION WITH CANNABIS OR CBD

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

Taking Xyrem with cannabis or cannabis products may worsen central nervous system depression with Xyrem. In fact, Xyrem has a boxed warning about this risk. This is a serious warning from the Food and Drug Administration (FDA). For more information, see “Boxed warnings” at the top of this article.

Before you start treatment with Xyrem, 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 and other factors may increase the risk of interactions with Xyrem. Before you take this drug, be sure to talk with your doctor about your health history. Xyrem 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 Xyrem include:

• Succinic semialdehyde dehydrogenase deficiency. Doctors typically won’t prescribe Xyrem if you have succinic semialdehyde dehydrogenase deficiency. This is a rare genetic (inherited) condition that can prevent your body from breaking down Xyrem as well as it should. For details, see the “When to avoid Xyrem” section above.
• Following a low sodium diet. Before taking Xyrem, tell your doctor if you’re following a low sodium diet. This includes a low sodium diet for kidney problems, heart failure, or high blood pressure. Xyrem contains a high amount of salt. If you’re tracking your daily salt intake, you’ll likely want to consider including the amount of salt in Xyrem. To learn about the salt content in each dose of Xyrem, see the drug’s prescribing information.
• Mental health conditions. Before starting Xyrem treatment, tell your doctor about any mental health conditions you have. This drug may cause certain mental health side effects, such as depression, anxiety, and suicidal thoughts or behaviors. As a result, Xyrem can worsen any mental health conditions you already have. Your doctor can advise whether Xyrem is a safe treatment option for you.
• Breathing problems. Before taking Xyrem, tell your doctor if you have any breathing problems. This includes conditions such as sleep apnea. Xyrem may cause respiratory depression (shallow or slow breathing), which can worsen your breathing problem. If you have a breathing problem, your doctor may not prescribe Xyrem for you. They can recommend a safer treatment option.
• Pregnancy. It’s not known for certain whether Xyrem is safe to take while pregnant. If you’re pregnant or planning a pregnancy, talk with your doctor before taking the medication. For details about Xyrem treatment during pregnancy, see this article.
• Breastfeeding. Xyrem can pass into breast milk, which may cause side effects in a child who’s breastfed. If you’re considering breastfeeding while taking Xyrem, talk with your doctor.
• Allergic reaction. If you’ve had an allergic reaction to Xyrem or any of its ingredients, your doctor will likely not prescribe Xyrem. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

You can take certain steps to help prevent interactions with Xyrem. 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 Xyrem 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 Xyrem 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 Xyrem by taking it exactly as your doctor prescribes.

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

• Overview of Xyrem. For a general overview of Xyrem, you can see this article.
• Drug comparison. For information about how Xyrem compares with Xywav, read this article.
• Facts about narcolepsy. To learn more about narcolepsy, see our science of sleep 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.