Drug interactions
Alprazolam + Levorphanol
Severity: Major
Alprazolam and Levorphanol: 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
Combining a benzodiazepine with an opioid such as levorphanol can cause profound sedation, respiratory depression, coma and death. Regulatory agencies carry boxed warnings for this combination.
What this interaction means in plain words
Alprazolam and Levorphanol 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.
Why it happens
Additive CNS and respiratory depression via GABA-A potentiation and mu-opioid receptor agonism.
What to do
Avoid concurrent use where possible; if needed, use the lowest effective doses for the shortest duration. Monitor closely for respiratory depression and sedation, and consider naloxone availability.
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
Frequently asked questions
Can I take Alprazolam with Levorphanol?
MediHelp rates the interaction as major. Alprazolam and Levorphanol 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. Combining a benzodiazepine with an opioid such as levorphanol can cause profound sedation, respiratory depression, coma and death. Regulatory agencies carry boxed warnings for this combination.
How serious is the interaction between Alprazolam and Levorphanol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid concurrent use where possible; if needed, use the lowest effective doses for the shortest duration. Monitor closely for respiratory depression and sedation, and consider naloxone availability.
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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