Drug interactions
Alprazolam + Nefazodone
Severity: Major
Alprazolam and Nefazodone: 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
Nefazodone strongly inhibits CYP3A4 and substantially increases alprazolam exposure, causing excessive sedation and psychomotor impairment. Alprazolam labeling advises against use with nefazodone.
What this interaction means in plain words
Alprazolam and Nefazodone 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
Inhibition of CYP3A4-mediated alprazolam metabolism by nefazodone.
What to do
Avoid the combination if possible; if used together, reduce the alprazolam starting dose by about half or more and monitor sedation. Consider lorazepam as an alternative.
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 Nefazodone?
MediHelp rates the interaction as major. Alprazolam and Nefazodone 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. Nefazodone strongly inhibits CYP3A4 and substantially increases alprazolam exposure, causing excessive sedation and psychomotor impairment. Alprazolam labeling advises against use with nefazodone.
How serious is the interaction between Alprazolam and Nefazodone?
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 the combination if possible; if used together, reduce the alprazolam starting dose by about half or more and monitor sedation. Consider lorazepam as an alternative.
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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