Drug interactions
Alprazolam + Fluvoxamine
Severity: Major
Alprazolam and Fluvoxamine: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Fluvoxamine substantially raises alprazolam plasma levels, which can increase sedation, psychomotor impairment and memory problems. Alprazolam labeling advises dose reduction with this combination.
What this interaction means in plain words
Alprazolam and Fluvoxamine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Alprazolam belongs to Central Nervous System; Fluvoxamine belongs to Central Nervous System.
Why it happens
Fluvoxamine inhibits CYP3A4, the main enzyme metabolizing alprazolam, reducing its clearance.
What to do
Reduce the alprazolam starting dose, often to about half or less, and titrate slowly while monitoring for sedation and respiratory depression. Consider another SSRI that does not inhibit CYP3A4 or a different anxiolytic strategy.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Alprazolam
- Alprazolam + Calcium / magnesium / potassium / sodium oxybates Contraindicated
- Alprazolam + Itraconazole Contraindicated
- Alprazolam + Ketoconazole Contraindicated
- Alprazolam + Levoketoconazole Contraindicated
- Alprazolam + Sodium oxybate Contraindicated
- Alfentanil + Alprazolam Major
Other interactions of Fluvoxamine
- Agomelatine + Fluvoxamine Contraindicated
- Alosetron + Fluvoxamine Contraindicated
Frequently asked questions
Can I take Alprazolam with Fluvoxamine?
MediHelp rates the interaction as major. Alprazolam and Fluvoxamine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Fluvoxamine substantially raises alprazolam plasma levels, which can increase sedation, psychomotor impairment and memory problems. Alprazolam labeling advises dose reduction with this combination.
How serious is the interaction between Alprazolam and Fluvoxamine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Reduce the alprazolam starting dose, often to about half or less, and titrate slowly while monitoring for sedation and respiratory depression. Consider another SSRI that does not inhibit CYP3A4 or a different anxiolytic strategy.
What other medicines interact with Alprazolam?
MediHelp also lists interactions of Alprazolam with, for example, Calcium / magnesium / potassium / sodium oxybates, Itraconazole, Ketoconazole. The full list is on the Alprazolam page.
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