Drug interactions
Alprazolam + St john's wort
Severity: Moderate
Alprazolam and St john's wort: 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
St John's wort induces CYP3A4 and can lower alprazolam concentrations, reducing its effect and potentially precipitating rebound anxiety or withdrawal symptoms.
What this interaction means in plain words
Alprazolam and St john's wort 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 St John's wort increases alprazolam clearance.
What to do
Avoid combining where possible, or monitor clinical response and adjust alprazolam dose. Reassess dose if St John's wort is stopped, since levels can rise again.
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 St john's wort?
MediHelp rates the interaction as moderate. Alprazolam and St john's wort 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. St John's wort induces CYP3A4 and can lower alprazolam concentrations, reducing its effect and potentially precipitating rebound anxiety or withdrawal symptoms.
How serious is the interaction between Alprazolam and St john's wort?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid combining where possible, or monitor clinical response and adjust alprazolam dose. Reassess dose if St John's wort is stopped, since levels can rise again.
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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