of full opioid agonists. There have been postmarketing reports of coma and death with coadministration of buprenorphine and benzodiazepines. In many, but not all of these cases, buprenorphine was misused by self-injection. If a benzodiazepine must be used for an indication other than seizures, lower the benzodiazepine initial dose and cautiously titrate to clinical response.buprenorphine, long-acting injectionalprazolam increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.butabarbitalbutabarbital will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.butabarbital and alprazolam both increase sedation. Use Caution/Monitor.butalbitalbutalbital will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.butalbital and alprazolam both increase sedation. Use Caution/Monitor.butorphanolalprazolam and butorphanol both increase sedation. Use Caution/Monitor.caffeinealprazolam increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.carbinoxaminecarbinoxamine and alprazolam both increase sedation. Use Caution/Monitor.carisoprodolalprazolam and carisoprodol both increase sedation. Use Caution/Monitor.cenobamatecenobamate will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.cenobamate, alprazolam. Either increases effects of the other by sedation. Use Caution/Monitor.chloral hydratealprazolam and chloral hydrate both increase sedation. Use Caution/Monitor.chlordiazepoxidealprazolam and chlordiazepoxide both increase sedation. Use Caution/Monitor.chlorpheniraminechlorpheniramine and alprazolam both increase sedation. Use Caution/Monitor.chlorpromazinealprazolam and chlorpromazine both increase sedation. Use Caution/Monitor.chlorzoxazonealprazolam and chlorzoxazone both increase sedation. Use Caution/Monitor.cinnarizinecinnarizine and alprazolam both increase sedation. Use Caution/Monitor.clemastineclemastine and alprazolam both increase sedation. Use Caution/Monitor.clobazamalprazolam, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).clomipraminealprazolam and clomipramine both increase sedation. Use Caution/Monitor.clonazepamalprazolam and clonazepam both increase sedation. Use Caution/Monitor.clonidineclonidine, alprazolam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.clorazepatealprazolam and clorazepate both increase sedation. Use Caution/Monitor.clozapinealprazolam and clozapine both increase sedation. Use Caution/Monitor.codeinealprazolam and codeine both increase sedation. Use Caution/Monitor.conivaptanconivaptan will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cortisonecortisone will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.crizotinibcrizotinib increases levels of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.crofelemercrofelemer increases levels of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.cyclizinecyclizine and alprazolam both increase sedation. Use Caution/Monitor.cyclobenzaprinealprazolam and cyclobenzaprine both increase sedation. Use Caution/Monitor.cyclosporinecyclosporine will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cyproheptadinecyproheptadine and alprazolam both increase sedation. Use Caution/Monitor.dabrafenibdabrafenib will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.dantrolenealprazolam and dantrolene both increase sedation. Use Caution/Monitor.daridorexantalprazolam and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. darifenacindarifenacin will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.darunavirdarunavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.dasatinibdasatinib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.deferasiroxdeferasirox will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.desfluranedesflurane and alprazolam both increase sedation. Use Caution/Monitor.desipraminealprazolam and desipramine both increase sedation. Use Caution/Monitor.deutetrabenazinealprazolam and deutetrabenazine both increase sedation. Use Caution/Monitor.dexamethasonedexamethasone will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.dexchlorpheniraminedexchlorpheniramine and alprazolam both increase sedation. Use Caution/Monitor.dexfenfluraminealprazolam increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dexmedetomidinealprazolam and dexmedetomidine both increase sedation. Use Caution/Monitor.dexmethylphenidatealprazolam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dextroamphetaminealprazolam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dextromoramidealprazolam and dextromoramide both increase sedation. Use Caution/Monitor.DHEA, herbalDHEA, herbal will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.diamorphinealprazolam and diamorphine both increase sedation. Use Caution/Monitor.diazepamalprazolam and diazepam both increase sedation. Use Caution/Monitor.diazepam intranasaldiazepam intranasal, alprazolam. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.diethylpropionalprazolam increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.difelikefalindifelikefalin and alprazolam both increase sedation. Use Caution/Monitor.difenoxin hclalprazolam and difenoxin hcl both increase sedation. Use Caution/Monitor.digoxinalprazolam increases levels of digoxin by unknown mechanism. Use Caution/Monitor.diltiazemdiltiazem will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for increased alprazolam side effects including drowsiness or fatigue, nausea, vomiting, diarrhea or constipation.dimenhydrinatedimenhydrinate and alprazolam both increase sedation. Use Caution/Monitor.diphenhydraminediphenhydramine and alprazolam both increase sedation. Use Caution/Monitor.diphenoxylate hclalprazolam and diphenoxylate hcl both increase sedation. Use Caution/Monitor.dipipanonealprazolam and dipipanone both increase sedation. Use Caution/Monitor.disulfiramdisulfiram increases levels of alprazolam by decreasing metabolism. Use Caution/Monitor.dobutaminealprazolam increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dopaminealprazolam increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dopexaminealprazolam increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dosulepinalprazolam and dosulepin both increase sedation. Use Caution/Monitor.doxepinalprazolam and doxepin both increase sedation. Use Caution/Monitor.doxylaminealprazolam and doxylamine both increase sedation. Use Caution/Monitor.dronedaronedronedarone will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.droperidolalprazolam and droperidol both increase sedation. Use Caution/Monitor.duvelisibduvelisib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. will increase the level or effect ofefavirenzefavirenz will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.elagolixelagolix will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.elvitegravir/cobicistat/emtricitabine/tenofovir DFelvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; consider benzodiazepine dose reduction.encorafenibencorafenib, alprazolam. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.ephedrinealprazolam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.epinephrinealprazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.epinephrine racemicalprazolam increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.esketamine intranasalesketamine intranasal, alprazolam. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.eslicarbazepine acetateeslicarbazepine acetate will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.estazolamalprazolam and estazolam both increase sedation. Use Caution/Monitor.ethanolalprazolam and ethanol both increase sedation. Use Caution/Monitor.ethinylestradiolethinylestradiol will increase the level or effect of alprazolam by Mechanism: decreasing metabolism. Use Caution/Monitor. Ethinyl estradiol may inhibit the clearance of benzodiazepines that undergo oxidation, thereby increasing serum concentrations of concomitantly administered benzodiazepines.etomidateetomidate and alprazolam both increase sedation. Use Caution/Monitor.etravirineetravirine will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.fedratinibfedratinib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.fenfluraminealprazolam increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.finerenonealprazolam will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or moderate CYP3A4 inhibitors. Adjust finererone dosage as needed.flibanserinalprazolam and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.fluconazolefluconazole will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.fludrocortisonefludrocortisone will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.fluphenazinealprazolam and fluphenazine both increase sedation. Use Caution/Monitor.flurazepamalprazolam and flurazepam both increase sedation. Use Caution/Monitor.fluvoxaminefluvoxamine will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.formoterolalprazolam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.fosamprenavirfosamprenavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.fosaprepitantfosaprepitant will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.fosphenytoinfosphenytoin will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.gabapentingabapentin, alprazolam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.gabapentin enacarbilgabapentin enacarbil, alprazolam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.ganaxolonealprazolam and ganaxolone both increase sedation. Use Caution/Monitor.grapefruitgrapefruit will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.griseofulvingriseofulvin will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.haloperidolalprazolam and haloperidol both increase sedation. Use Caution/Monitor.hyaluronidasehyaluronidase, alprazolam. Other (see comment). Use Caution/Monitor. Comment: Drug combination has been found to be incompatible.hydrocortisonehydrocortisone will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.hydromorphonealprazolam and hydromorphone both increase sedation. Use Caution/Monitor.hydroxyzinehydroxyzine and alprazolam both increase sedation. Use Caution/Monitor.iloperidonealprazolam and iloperidone both increase sedation. Use Caution/Monitor.iloperidone increases levels of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.imipraminealprazolam and imipramine both increase sedation. Use Caution/Monitor.indinavirindinavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.isavuconazonium sulfatealprazolam will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.isoniazidisoniazid will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.isoproterenolalprazolam increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.istradefyllineistradefylline will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.ketamineketamine and alprazolam both increase sedation. Use Caution/Monitor.ketotifen, ophthalmicalprazolam and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.lapatiniblapatinib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.lasmiditanlasmiditan, alprazolam. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.lemborexantalprazolam will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.lemborexant, alprazolam. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.lenacapavirlenacapavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.letermovirletermovir increases levels of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.levalbuterolalprazolam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.levonorgestrel oral/ethinylestradiol/ferrous bisglycinatelevonorgestrel oral/ethinylestradiol/ferrous bisglycinate will increase the level or effect of alprazolam by decreasing metabolism. Use Caution/Monitor. Ethinyl estradiol may