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As is the case with any other medication, there may be some instances where Xanax interactions can occur. In such cases, use is not recommended, or usage will have to be adjusted in order to prevent or reduce the risk of negative interactions occurring from other drugs, medical conditions, or even food and drink.

Drug Interactions

According to the FDA, drugs that may interact with Xanax (alprazolam) include the following.

  • Ketoconazole (Nizoral)
  • Itraconazole (Sporanox)
  • Desipramine (Norpramin)
  • Fluoxetine (Prozac)
  • Propoxyphene (Darvon)
  • CYP3a inhibitors
  • Opioids, such as oxycodone (OxyContin) and hydrocodone (Vicodin)
  • Other CNS depressants like barbiturates [e.g., butabarbital (Butisol)]
  • Oral contraceptives (aka hormonal birth control; patients should explore non-hormonal birth control methods)

Please note that this list may not be complete, and other interactions with drugs not listed here may occur.

Xanax and Tylenol

There is no indication that Xanax interacts with Tylenol (acetaminophen), and no warnings about taking them together. One should always consult a healthcare provider before mixing medications, though.

Xanax and Tylenol PM

Taking Xanax with Tylenol PM (acetaminophen plus diphenhydramine) might increase the side effects of both medications, including sleepiness, dizziness, and confusion. 

Xanax and Lisinopril

Lisinopril (Qbrelis, Zestril, Prinivil) is an ACE inhibitor that lowers blood pressure. Combining it with Xanax may make blood pressure extremely low, leading to dizziness, headache, fainting, and changes in heart rate. These side effects are more likely to occur when first taking Xanax or lisinopril together or when the dosage changes. 

Alprazolam and Melatonin

There are some indications that combining alprazolam and melatonin may increase the sedative effect. 

Alprazolam and Buspirone

Both buspirone (Buspar) and alprazolam are for the treatment of anxiety disorders. There is no clear indication of interaction between them, though. That said, one should only combine these medications at the recommendation of a healthcare provider. 

Alprazolam and Metoprolol

Metoprolol (Toprol XL, Lopressor) treats high blood pressure and chest pain from poor blood flow to the heart. Both metoprolol and alprazolam lower blood pressure, so taking them together might have unexpected consequences. These consequences include dizziness, headache, fainting, and change in heart rate.  

Alprazolam and Methadone

Methadone (Diskets, Methadone Intensol, Methadose) and alprazolam are both central nervous system depressants. Taking them together will intensify the effects. It may increase the risk of overdose, as well. 

Food Interactions

Sometimes the foods we eat and the beverages we drink can also interact with our medications. Food and drink that may interact with Xanax include:

  • Grapefruit
  • Grapefruit juice

Please note that this list may not be complete, and there may be other foods and beverages that interact with this drug.

Xanax and Drinking Alcohol

For more information, please visit our page on Xanax and alcohol interactions. 

Xanax and Grapefruit

Grapefruit, grapefruit juice, and foods containing either can interact with alprazolam and may have dangerous side effects, including slowed breathing. 

Alprazolam and Aged Meats

There is no indication that aged meats interact with alprazolam. 

Disease & Conditions Interactions

Sometimes certain medications can increase the risk of negative side effects for patients with certain diseases or other medical conditions. According to the FDA, diseases, and medical conditions that are known to negatively interact with Xanax include:

  • Narrow-angle glaucoma (closed-angle glaucoma, acute angle-closure glaucoma)
  • Alcoholism
  • Alcoholic liver disease
  • Impaired hepatic (liver) function 
  • Impaired renal (kidney) function 
  • Obesity
  • Older adults may be more sensitive to this drug
  • Smoking

Please note that this list may not be complete, and there may be other diseases and medical conditions where patients should not take this medication.

Xanax and Pregnancy

For more information, please visit our page on Xanax and pregnancy risks.

Alprazolam and Dementia

Clinical evidence suggests that the risk of developing dementia may be significantly higher for those who take benzodiazepines like Xanax over extended periods of time. A recent study also found giving benzodiazepines to Alzheimer’s patients might contribute to an early death.

Disclaimer: this article does not constitute or replace medical advice. If you have an emergency or a serious medical question, please contact a medical professional or call 911 immediately. To see our full medical disclaimer, visit our Terms of Use page.


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