Drug interactions
Alprazolam + Rifampin
Severity: Moderate
Alprazolam and Rifampin: 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
Rifampin strongly induces CYP3A4 and can markedly reduce alprazolam concentrations, leading to loss of efficacy and possible withdrawal or rebound anxiety. The effect persists for some time after rifampin is stopped.
What this interaction means in plain words
Alprazolam and Rifampin 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.
Why it happens
Induction of CYP3A4 by rifampin accelerates alprazolam metabolism.
What to do
Monitor clinical response and increase the alprazolam dose if required, or use a benzodiazepine cleared by glucuronidation such as lorazepam. Reassess the dose when rifampin is discontinued.
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
Frequently asked questions
Can I take Alprazolam with Rifampin?
MediHelp rates the interaction as moderate. Alprazolam and Rifampin 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. Rifampin strongly induces CYP3A4 and can markedly reduce alprazolam concentrations, leading to loss of efficacy and possible withdrawal or rebound anxiety. The effect persists for some time after rifampin is stopped.
How serious is the interaction between Alprazolam and Rifampin?
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 clinical response and increase the alprazolam dose if required, or use a benzodiazepine cleared by glucuronidation such as lorazepam. Reassess the dose when rifampin is discontinued.
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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