Drug interactions
Alprazolam + Mifepristone
Severity: Major
Alprazolam and Mifepristone: 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
Mifepristone inhibits CYP3A4 and can raise alprazolam concentrations, with more sedation and psychomotor impairment. The effect is likely larger with the long-term, higher doses used for Cushing syndrome.
What this interaction means in plain words
Alprazolam and Mifepristone 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; Mifepristone belongs to Endocrine.
Why it happens
Inhibition of CYP3A4-mediated alprazolam metabolism by mifepristone.
What to do
Use the lowest effective alprazolam dose and monitor closely for oversedation and respiratory depression. Consider an alternative anxiolytic that is not CYP3A4-dependent if the patient is on chronic mifepristone.
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 Mifepristone?
MediHelp rates the interaction as major. Alprazolam and Mifepristone 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. Mifepristone inhibits CYP3A4 and can raise alprazolam concentrations, with more sedation and psychomotor impairment. The effect is likely larger with the long-term, higher doses used for Cushing syndrome.
How serious is the interaction between Alprazolam and Mifepristone?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use the lowest effective alprazolam dose and monitor closely for oversedation and respiratory depression. Consider an alternative anxiolytic that is not CYP3A4-dependent if the patient is on chronic mifepristone.
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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