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Does CBD Interact With Alprazolam (Xanax)?

Information on risks & possible interactions between CBD & alprazolam.

Article By
Daily CBD , last updated on October 20, 2021

The use of CBD is gaining rapid momentum because of its safety and effectiveness in treating a host of medical conditions, including anxiety and insomnia.

This has many wondering whether CBD is safe to use with the common anti-anxiety medication, alprazolam (Xanax), and whether CBD is a safer alternative or not.

Here, we’ll explore the potential drug interactions between CBD and alprazolam.

Illustration of a bottle full of alprazolam pils.

Does CBD Interact With Alprazolam (Xanax)?

When used in conjunction with psychotropic medicines like alprazolam (Xanax), CBD may cause moderate to severe risk of negative interactions or side effects.

The main issue with this combination is that CBD interferes or slows the metabolism of alprazolam, thus increasing the chances for side effects to occur.

1. Slowed Elimination (Metabolic Inhibition)

Drug metabolism is the process of breaking down the drugs inside the body via various enzymes, mainly for the ease of excretion. A family of liver enzymes called cytochrome P450 is responsible for the metabolism of most of the drugs in the human body. Alprazolam is extensively metabolized and eliminated via cytochrome P4503A4 (CYP3A4).

Studies have concluded that CBD most potently inhibits the CYP3A4 system of enzymes [1]. Most interactions with alprazolam are with drugs that inhibit or induce CYP3A4.

Compounds that are potent inhibitors of CYP3A tend to increase plasma alprazolam concentrations. Drugs that inhibit this metabolic pathway may have a profound effect on the clearance of alprazolam.

Without proper metabolism, a drug may remain in the system longer than is necessary and cause unintended adverse effects.

CBD is also metabolized by the same sets of enzymes as alprazolam. Hence, CBD may compete for or interfere with these enzymes, leading to an altered concentration of alprazolam in the body. Such an interaction is called metabolic competition. It is the most common type of interaction between CBD and other medications.

2. Increased Effect (Agonistic Interaction)

When CBD is consumed together with alprazolam (Xanax), these drugs enhance each other’s actions. This combination can result in a marked increase in the final effects of these medicines that can be more harmful than beneficial.

An agonistic interaction occurs when two or more substances exhibit the same effect on the body. These substances might act on the same or different receptors, but they produce certain effects in the same direction when consumed together.

CBD and alprazolam may exhibit compounded effects towards the sedative, muscle-relaxant, and hypotensive effects. Both substances exert a similar influence in these areas and may cause side effects from causing too strong of a push in this direction.

Side effects of this interaction would include dizziness, lightheadedness, fatigue, and fainting.

Patients need to exercise caution and should only take these medicines together under the close monitoring of a physician.

List of Alprazolam Trade Names

Alprazolam is sold under many different names. All share the same risk and potential interactions.

Other names for alprazolam include:

  • Xanax
  • Xanor
  • Niravam

Similar Medications

Alprazolam is classified as a benzodiazepine. CBD and benzodiazepines all share similar risks for interaction and side effects.

Here’s a list of similar medications that share a similar level of risk when combined with CBD:

  • Chlordiazepoxide (Librium)
  • Clonazepam (Klonopin)
  • Clorazepate (Tranxene)
  • Diazepam (Valium)
  • Estazolam (Prosom)
  • Flurazepam (Dalmane)
  • Lorazepam (Ativan)
  • Midazolam (Versed)
  • Oxazepam (Serax)
  • Temazepam (Restoril)
  • Triazolam (Halcion)
  • Quazepam (Doral)

Is It Safe to Take CBD & Alprazolam (Xanax) Together?

Low doses of CBD are generally considered safe to use with alprazolam (Xanax). However, you should always speak with your prescribing physician about combining CBD or any supplements alongside alprazolam. Other factors or medications could contraindicate the use of CBD.

It’s also not a good idea to use large doses of CBD, THC, or other cannabinoids alongside alprazolam or other benzodiazepines.

Side effects are compounded to dangerous levels if alcohol is used in combination with CBD and alprazolam.

Hence, one must exercise extreme caution while consuming these medicines together. It may alter the concentrations of benzodiazepines and influence either safety or efficacy. It is mandatory to consult a trained physician if anyone seeks to combine or replace alprazolam with CBD.

Is CBD a Viable Alternative to Alprazolam (Xanax)?

CBD carries a host of anti-anxiety benefits without interfering with the patient’s well-being and daily functioning as it is both non-intoxicating and non-psychoactive. Hence, patients are keen to use CBD to treat various disorders like seizures, schizophrenia, anxiety, cancer, chronic pain, and inflammation as a natural alternative and adjunct to other pharmaceutical medicines.

It restores the balance of the endocannabinoid system (ECS) by interacting with cannabinoid (CB) receptors throughout the human body. CBD might be effective and safe in treating conditions such as anxiety and panic disorders with fewer side effects than benzodiazepines [2, 3].

Hence, it is tempting to replace traditional anxiolytics with CBD to beat the blues. However, stopping anxiolytics like alprazolam abruptly can result in withdrawal. Alprazolam, like other benzodiazepines, can result in drug dependence even when used within the prescribed doses for a short time.

When alprazolam (Xanax)  is stopped suddenly, several systems of the body get affected. Blood pressure, temperature, respiration, and heart rate may increase rapidly. Seizures that can result in coma and even death may also occur.

Some of the physical warning signs of alprazolam withdrawal include:

  • Headache
  • Blurred vision
  • Myalgia and tremors
  • Tension in the jaw and/or toothache
  • Nausea/Vomiting
  • Diarrhea
  • Numbness and Tingling in the fingers, arms, and legs
  • Photosensitivity/ Sensitivity to sound
  • Altered sense of smell
  • Loss of appetite
  • Insomnia
  • Cramps
  • Heart palpitations
  • Hypertension
  • Sweating and/or fever
  • Delirium

Some of the psychological symptoms of alprazolam withdrawal are:

  • Anxiety
  • Panic
  • Thoughts of suicide
  • Hallucinations
  • Depression
  • Paranoia
  • Inability to control emotions
  • Short-term memory loss
  • Nightmares
  • Mood swings
  • Trouble concentrating

Hence, one must be extremely cautious before combining or replacing alprazolam with CBD. Whether by decreasing the dose of alprazolam or spacing the two medications, a trained physician will be able to devise the most appropriate way to include CBD in the treatment regime.

Patients should discuss in detail their reason to make such a change with their doctors. After understanding your health condition and evaluating the safety and effectiveness, a doctor will guide you on the best possible method to incorporate such natural anxiolytics either as an alternative or an adjunct to your current medications.

Alprazolam may need to be tapered gradually over several days or weeks to minimize the side effects and suffering of the patient. A physician with adequate knowledge of the use of CBD and alprazolam in the treatment of anxiety/panic disorder will be able to advise you on the right way of making the shift.

What Is Alprazolam (Xanax)?

Alprazolam (Xanax) is a prescription medicine of the class “triazolobenzodiazepines.”

It’s the most commonly prescribed psychotropic medication for the treatment of anxiety and panic disorders.

Alprazolam is a schedule IV controlled substance in the USA. Alprazolam, like other benzodiazepines, works by enhancing the activity of GABA, a natural chemical compound in the human body.

Alprazolam (Xanax) Specs:

Drug NameAlprazolam
Trade NameXanax, Xanax XR, Niravam
ClassificationTriazolobenzodiazepine, Benzodiazepine
CYP MetabolismCYP3A4
Interaction with CBDMetabolic inhibition
Risk of InteractionModerate

What Does Alprazolam (Xanax) Do?

Alprazolam (Xanax) is a highly potent triazolobenzodiazepine indicated in the treatment of anxiety and panic disorders. It is also used as an adjunct to other treatment modalities to treat chemotherapy-induced nausea and vomiting.

Some of the off-the-label uses of alprazolam include reducing the aches, irritability, and tension of premenstrual syndrome. Alprazolam binds two benzodiazepine receptors in the central nervous system, BNZ1 and BNZ2, respectively.

The BNZ1 receptor is responsible for sleep regulation, while BZN2  is mainly concerned with muscle relaxation, memory, anticonvulsant activity, and coordination.

The binding activity of alprazolam causes a calming effect on the body by increasing the action of a chemical called gamma-aminobutyric acid (GABA). GABA is an inhibitory neurotransmitter, which means it slows down neuronal activity in the central nervous system. This results in reduced anxiousness and muscle relaxation and can also cause drowsiness.

What Are the Side Effects of Alprazolam (Xanax)?

Alprazolam (Xanax) has many potential side effects. Most of them are mild, but a few can become pretty severe. Side effects become more common with higher doses or long-term use.

The potential side effects of alprazolam include:

  • Agitation/Irritability
  • Blurred vision
  • Changes in libido
  • Confusion
  • Constipation or diarrhea
  • Drowsiness/Lightheadedness
  • Dry mouth
  • Headache
  • Hypotension
  • Increased Salivation
  • Insomnia/Dream abnormalities
  • Memory impairment
  • Muscle tone disorder
  • Nasal congestion
  • Nausea/Vomiting
  • Tachycardia
  • Tinnitus
  • Weakness
  • Weight gain or loss

These side effects generally appear at the beginning of the treatment and are short-lived and self-resolving. However, some symptoms might linger for a longer period.

Additionally, some rare but serious effects may occur following the consumption of alprazolam, such as:

  • Seizures
  • Mental changes (such as hallucinations, thoughts of suicide)
  • Yellowing of eyes or skin
  • Severe allergies
  • Addiction
  • Severe lapses in memory

Precautions While Taking Alprazolam (Xanax)

The following issues need to be discussed with the treating physician while consuming alprazolam (Xanax) for your health condition:

Concomitant Use With Opioids

When alprazolam is used with opioid drugs, it might cause potentially fatal respiratory depression and sedation. These medicines shouldn’t be used concomitantly unless supervised by a health care provider. Patients shouldn’t drive or operate heavy machinery until the effects of this combination have been determined.

Alcohol

Patients should avoid consumption of any alcoholic beverages as it might lead to fatal interactions.

Concomitant Medication

If the patient is on or plans to take any prescription or over-the-counter drugs, it must be discussed with their physician due to the risk of potential interactions.

Pregnancy

Alprazolam (Xanax) is contraindicated to use during pregnancy. Therefore, physicians should be informed if anyone is pregnant or planning to have a child or become pregnant while taking this medication.

Nursing

Patients should not breastfeed their children if they are taking alprazolam.

Interference With Cognitive & Motor Performance

Until one knows how this medication affects them, activities that require mental alertness and motor coordination, such as driving, should be avoided.

Dosage Adjustment

The dosage of this medicine shouldn’t be altered without consulting the treating physician, even if one feels that the medication isn’t working. Benzodiazepines, even when used as recommended, may produce emotional and physical dependence.

Cessation

This medication shouldn’t be stopped abruptly without consulting the physician since serious withdrawal symptoms can occur.

Key Takeaways: Is It Safe to Take Alprazolam With CBD?

Alprazolam (Xanax) and CBD are both effective in the treatment of anxiety and panic disorders. However, as CBD inhibits the enzymes needed for the metabolism of alprazolam, these can interact easily, leading to adverse effects. Hence, it is generally recommended not to mix these two medications.

However, if anyone is willing to use CBD alongside or replace alprazolam, they must do it under the supervision of a physician. During the concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression.

Cautious dosage titration may be required, especially at the beginning of the treatment. Patients must notify their physician if they experience excessive or prolonged effects that interfere with their normal activities.

References

  1. Yamaori, S., Ebisawa, J., Okushima, Y., Yamamoto, I., & Watanabe, K. (2011). Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol: role of phenolic hydroxyl groups in the resorcinol moiety. Life sciences, 88(15-16), 730-736.
  2. Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R. (2015). Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics, 12(4), 825-836.
  3. Schier, A. R. D. M., Ribeiro, N. P. D. O., Silva, A. C. D. O., Hallak, J. E. C., Crippa, J. A. S., Nardi, A. E., & Zuardi, A. W. (2012). Cannabidiol, a Cannabis sativa constituent, as an anxiolytic drug. Brazilian Journal of Psychiatry, 34, 104-110.

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