Drug interactions
Alprazolam + Primidone
Severity: Moderate
Alprazolam and Primidone: moderate 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
Primidone, partly metabolized to phenobarbital, induces CYP3A4 and can reduce alprazolam exposure and effect. Both drugs also cause CNS depression, so sedation may be additive.
What this interaction means in plain words
Alprazolam and Primidone can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Alprazolam belongs to Central Nervous System; Primidone belongs to Central Nervous System.
Why it happens
CYP3A4 induction by primidone and its phenobarbital metabolite lowers alprazolam levels, with additive GABAergic sedation.
What to do
Monitor for reduced alprazolam effect and for excessive sedation, and adjust the alprazolam dose as needed. Reassess when primidone is started, changed or stopped.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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 Primidone
- Abiraterone + Primidone Major
Frequently asked questions
Can I take Alprazolam with Primidone?
MediHelp rates the interaction as moderate. Alprazolam and Primidone can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Primidone, partly metabolized to phenobarbital, induces CYP3A4 and can reduce alprazolam exposure and effect. Both drugs also cause CNS depression, so sedation may be additive.
How serious is the interaction between Alprazolam and Primidone?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for reduced alprazolam effect and for excessive sedation, and adjust the alprazolam dose as needed. Reassess when primidone is started, changed or stopped.
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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