4 known interactions • 3 major • 1 moderate • 0 minor
Always disclose all medications to your healthcare providers — prescription medicines, OTC medications, vitamins, and herbal supplements. This list may not include every possible interaction. Use our Medicine Interaction Checker to screen your complete medication list.
Potentially life-threatening or causing permanent damage. Avoid combination.
May worsen condition or require dose adjustment. Monitor closely.
Usually limited clinical effect. Manage with routine monitoring.
Opioids (oxycodone, hydrocodone, morphine, methadone)
Profoundly additive CNS and respiratory depression. FDA black box warning on all benzodiazepine and opioid labels. Risk of fatal respiratory depression.
Management: Avoid combination when possible. If both necessary: lowest effective doses, shortest duration, close monitoring.
Alcohol
Additive CNS depression. Both enhance GABA-A activity. Risk of severe sedation, respiratory depression, coma, and death.
Management: Absolutely avoid alcohol during alprazolam therapy. Counsel patients emphatically.
CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir, erythromycin)
CYP3A4 inhibitors dramatically increase alprazolam plasma levels. Ketoconazole increases AUC by ~15-fold.
Management: Contraindicated with azole antifungals and ritonavir. Use with extreme caution with other CYP3A4 inhibitors; reduce alprazolam dose significantly.
CNS depressants (antihistamines, muscle relaxants, antipsychotics)
Additive sedation and CNS depression.
Management: Use with caution; reduce doses; warn patients about driving and operating machinery.
Always ask your pharmacist about potential interactions with food, alcohol, and supplements specific to Alprazolam. Some medicines have significant interactions with grapefruit juice, high-fat meals, dairy products, or vitamin K-rich foods.