CYP3A4 metabolism. Use Caution/Monitor.lurasidoneMonitor Closely (1)lurasidone, alprazolam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.maprotilineMonitor Closely (1)alprazolam and maprotiline both increase sedation. Use Caution/Monitor.marijuanaMonitor Closely (2)marijuana will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. alprazolam and marijuana both increase sedation. Use Caution/Monitor.melatoninMonitor Closely (1)alprazolam and melatonin both increase sedation. Use Caution/Monitor.meperidineMonitor Closely (1)alprazolam and meperidine both increase sedation. Use Caution/Monitor.meprobamateMonitor Closely (1)alprazolam and meprobamate both increase sedation. Use Caution/Monitor.metaproterenolMonitor Closely (1)alprazolam increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.metaxaloneMonitor Closely (1)alprazolam and metaxalone both increase sedation. Use Caution/Monitor.methadoneMonitor Closely (1)alprazolam and methadone both increase sedation. Use Caution/Monitor.methamphetamineMonitor Closely (1)alprazolam increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.methocarbamolMonitor Closely (1)alprazolam and methocarbamol both increase sedation. Use Caution/Monitor.methylenedioxymethamphetamineMonitor Closely (1)alprazolam increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.methylprednisoloneMonitor Closely (1)methylprednisolone will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.metoclopramide intranasalSerious - Use Alternative (1)alprazolam, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.metronidazoleMonitor Closely (1)metronidazole will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.miconazole vaginalMonitor Closely (1)miconazole vaginal will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.midazolamMonitor Closely (1)alprazolam and midazolam both increase sedation. Use Caution/Monitor.midazolam intranasalMonitor Closely (2)alprazolam will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation. midazolam intranasal will increase the level or effect of alprazolam by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.midodrineMonitor Closely (1)alprazolam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.mifepristoneMonitor Closely (1)mifepristone will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.mirtazapineMonitor Closely (1)alprazolam and mirtazapine both increase sedation. Use Caution/Monitor.mitotaneMonitor Closely (1)mitotane decreases levels of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.modafinilMonitor Closely (1)alprazolam increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.morphineMonitor Closely (1)alprazolam and morphine both increase sedation. Use Caution/Monitor.motherwortMonitor Closely (1)alprazolam and motherwort both increase sedation. Use Caution/Monitor.moxifloxacinMinor (1)moxifloxacin increases levels of alprazolam by decreasing metabolism. Minor/Significance Unknown.moxonidineMonitor Closely (1)alprazolam and moxonidine both increase sedation. Use Caution/Monitor.nabiloneMonitor Closely (1)alprazolam and nabilone both increase sedation. Use Caution/Monitor.nalbuphineMonitor Closely (1)alprazolam and nalbuphine both increase sedation. Use Caution/Monitor.nefazodoneSerious - Use Alternative (1)nefazodone will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.nelfinavirMonitor Closely (1)nelfinavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nevirapineMonitor Closely (1)nevirapine will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nifedipineMonitor Closely (1)nifedipine will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nilotinibMonitor Closely (1)nilotinib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nirmatrelvir/ritonavirMonitor Closely (1)nirmatrelvir/ritonavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Consider lowering alprazolam dosing when coadministered with nirmatrelvir/ritonavirnorepinephrineMonitor Closely (1)alprazolam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptylineMonitor Closely (1)alprazolam and nortriptyline both increase sedation. Use Caution/Monitor.ofloxacinMinor (1)ofloxacin increases levels of alprazolam by decreasing metabolism. Minor/Significance Unknown.olanzapineMonitor Closely (1)alprazolam and olanzapine both increase sedation. Use Caution/Monitor.oliceridineMonitor Closely (1)oliceridine, alprazolam. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.olopatadine intranasalSerious - Use Alternative (1)alprazolam and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)Monitor Closely (1)ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Consider decreasing alprazolam dose based on clinical responseomeprazoleMinor (1)omeprazole increases levels of alprazolam by decreasing metabolism. Minor/Significance Unknown.opium tinctureMonitor Closely (1)alprazolam and opium tincture both increase sedation. Use Caution/Monitor.orphenadrineMonitor Closely (1)alprazolam and orphenadrine both increase sedation. Use Caution/Monitor.oxazepamMonitor Closely (1)alprazolam and oxazepam both increase sedation. Use Caution/Monitor.oxcarbazepineMonitor Closely (1)oxcarbazepine will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.oxycodoneMonitor Closely (1)alprazolam and oxycodone both increase sedation. Use Caution/Monitor.oxymorphoneMonitor Closely (1)alprazolam and oxymorphone both increase sedation. Use Caution/Monitor.paliperidoneMonitor Closely (1)alprazolam and paliperidone both increase sedation. Use Caution/Monitor.papaveretumMonitor Closely (1)alprazolam and papaveretum both increase sedation. Use Caution/Monitor.papaverineMonitor Closely (1)alprazolam and papaverine both increase sedation. Use Caution/Monitor.pentazocineMonitor Closely (1)alprazolam and pentazocine both increase sedation. Use Caution/Monitor.pentobarbitalMonitor Closely (2)pentobarbital will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. pentobarbital and alprazolam both increase sedation. Use Caution/Monitor.perampanelMonitor Closely (1)perampanel and alprazolam both increase sedation. Use Caution/Monitor.perphenazineMonitor Closely (1)alprazolam and perphenazine both increase sedation. Use Caution/Monitor.phendimetrazineMonitor Closely (1)alprazolam increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenobarbitalMonitor Closely (2)phenobarbital will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. phenobarbital and alprazolam both increase sedation. Use Caution/Monitor.phentermineMonitor Closely (1)alprazolam increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenylephrineMonitor Closely (1)alprazolam increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenylephrine POMonitor Closely (1)alprazolam increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .phenytoinMonitor Closely (1)phenytoin will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.pholcodineMonitor Closely (1)alprazolam and pholcodine both increase sedation. Use Caution/Monitor.pimozideMonitor Closely (1)alprazolam and pimozide both increase sedation. Use Caution/Monitor.pirbuterolMonitor Closely (1)alprazolam increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.posaconazoleMonitor Closely (1)posaconazole will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.prednisoneMonitor Closely (1)prednisone will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.pregabalinMonitor Closely (1)pregabalin, 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.primidoneMonitor Closely (2)primidone will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. primidone and alprazolam both increase sedation. Use Caution/Monitor.prochlorperazineMonitor Closely (1)alprazolam and prochlorperazine both increase sedation. Use Caution/Monitor.promethazineMonitor Closely (1)promethazine and alprazolam both increase sedation. Use Caution/Monitor.propofolMonitor Closely (1)propofol and alprazolam both increase sedation. Use Caution/Monitor.propylhexedrineMonitor Closely (1)alprazolam increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.protriptylineMonitor Closely (1)alprazolam and protriptyline both increase sedation. Use Caution/Monitor.quazepamMonitor Closely (1)alprazolam and quazepam both increase sedation. Use Caution/Monitor.quetiapineMonitor Closely (1)alprazolam and quetiapine both increase sedation. Use Caution/Monitor.quinupristin/dalfopristinMonitor Closely (1)quinupristin/dalfopristin will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.ramelteonMonitor Closely (1)alprazolam and ramelteon both increase sedation. Use Caution/Monitor.remimazolamMonitor Closely (1)remimazolam, alprazolam. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.ribociclibMonitor Closely (1)ribociclib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifabutinSerious - Use Alternative (1)rifabutin will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.Minor (1)rifabutin decreases levels of alprazolam by increasing metabolism. Minor/Significance Unknown.rifampinSerious - Use Alternative (1)rifampin will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.rifapentineMonitor Closely (1)rifapentine will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.risperidoneMonitor Closely (1)alprazolam and risperidone both increase sedation. Use Caution/Monitor.ritonavirMonitor Closely (1)ritonavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rucaparibMonitor Closely (1)rucaparib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.rufinamideMonitor Closely (1)rufinamide will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.sageMinor (1)alprazolam and sage both increase sedation. Minor/Significance Unknown.salmeterolMonitor Closely (1)alprazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.saquinavirSerious - Use Alternative (1)saquinavir increases levels of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Avoid coadministration. If need to use, decrease alprazolam dose.scullcapMonitor Closely (1)alprazolam and scullcap both increase sedation. Use Caution/Monitor.secobarbitalMonitor Closely (2)secobarbital will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. secobarbital and alprazolam both increase sedation. Use Caution/Monitor.selinexorSerious - Use Alternative (1)selinexor, alprazolam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.sevofluraneMonitor Closely (1)sevoflurane and alprazolam both increase sedation. Use Caution/Monitor.shepherd's purseMonitor Closely (1)alprazolam and shepherd's purse both increase sedation. Use Caution/Monitor.sodium oxybateSerious - Use Alternative (1)alprazolam, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.sofosbuvir/velpatasvirMonitor Closely (1)sofosbuvir/velpatasvir increases levels of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Velpatasvir inhibits CYP3A4. Caution if coadministered with drugs with narrow therapeutics indexes.St John's WortSerious - Use Alternative (1)St John's Wort will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.stiripentolMonitor Closely (2)stiripentol, alprazolam. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence. stiripentol, alprazolam. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.sufentanilMonitor Closely (1)alprazolam and sufentanil both increase sedation. Use Caution/Monitor.sufentanil SLSerious - Use Alternative (1)sufentanil SL, alprazolam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.suvorexantMonitor Closely (1)suvorexant and alprazolam both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessarytapentadolMonitor Closely (1)alprazolam and tapentadol both increase sedation. Use Caution/Monitor.tazemetostatMonitor Closely (2)tazemetostat will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. alprazolam will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tecovirimatMonitor Closely (1)tecovirimat will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.teduglutideMonitor Closely (1)teduglutide increases levels of alprazolam by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow