the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.acetazolamideMinor (1)acetazolamide will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.acrivastineMonitor Closely (1)acrivastine and alprazolam both increase sedation. Use Caution/Monitor.albuterolMonitor Closely (1)alprazolam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.alfentanilMonitor Closely (1)alprazolam and alfentanil both increase sedation. Use Caution/Monitor.amisulprideMonitor Closely (1)amisulpride and alprazolam both increase sedation. Use Caution/Monitor.amitriptylineMonitor Closely (1)alprazolam and amitriptyline both increase sedation. Use Caution/Monitor.amobarbitalMonitor Closely (2)amobarbital will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. amobarbital and alprazolam both increase sedation. Use Caution/Monitor.amoxapineMonitor Closely (1)alprazolam and amoxapine both increase sedation. Use Caution/Monitor.anastrozoleMinor (1)anastrozole will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.apalutamideSerious - Use Alternative (1)apalutamide will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.apomorphineMonitor Closely (1)alprazolam and apomorphine both increase sedation. Use Caution/Monitor.aprepitantMonitor Closely (1)aprepitant will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.arformoterolMonitor Closely (1)alprazolam increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.aripiprazoleMonitor Closely (1)alprazolam and aripiprazole both increase sedation. Use Caution/Monitor.armodafinilMonitor Closely (2)armodafinil will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. alprazolam increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.artemether/lumefantrineMonitor Closely (1)artemether/lumefantrine will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.asenapineMonitor Closely (1)asenapine and alprazolam both increase sedation. Use Caution/Monitor.asenapine transdermalMonitor Closely (1)asenapine transdermal and alprazolam both increase sedation. Use Caution/Monitor.atazanavirMonitor Closely (1)atazanavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.atogepantMonitor Closely (1)alprazolam will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.avapritinibMonitor Closely (2)alprazolam will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. avapritinib and alprazolam both increase sedation. Use Caution/Monitor.azelastineMonitor Closely (1)azelastine and alprazolam both increase sedation. Use Caution/Monitor.baclofenMonitor Closely (1)alprazolam and baclofen both increase sedation. Use Caution/Monitor.belladonna and opiumMonitor Closely (1)alprazolam and belladonna and opium both increase sedation. Use Caution/Monitor.belzutifanMonitor Closely (1)belzutifan will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information. benperidolMonitor Closely (1)alprazolam and benperidol both increase sedation. Use Caution/Monitor.benzhydrocodone/acetaminophenSerious - Use Alternative (2)benzhydrocodone/acetaminophen, alprazolam. Either increases toxicity 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. benzhydrocodone/acetaminophen and alprazolam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebenzphetamineMonitor Closely (1)alprazolam increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.bosentanMonitor Closely (1)bosentan will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.brexanoloneMonitor Closely (1)brexanolone, alprazolam. Either increases toxicity of the other by sedation. Use Caution/Monitor.brexpiprazoleMonitor Closely (1)brexpiprazole and alprazolam both increase sedation. Use Caution/Monitor.brimonidineMonitor Closely (1)brimonidine and alprazolam both increase sedation. Use Caution/Monitor.Minor (1)brimonidine increases effects of alprazolam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.brivaracetamMonitor Closely (1)brivaracetam and alprazolam both increase sedation. Use Caution/Monitor.brompheniramineMonitor Closely (1)brompheniramine and alprazolam both increase sedation. Use Caution/Monitor.budesonideMonitor Closely (1)budesonide will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.buprenorphineMonitor Closely (1)alprazolam and buprenorphine both increase sedation. Use Caution/Monitor.buprenorphine buccalMonitor Closely (1)alprazolam and buprenorphine buccal both increase sedation. Use Caution/Monitor.buprenorphine subdermal implantMonitor Closely (1)alprazolam increases toxicity of buprenorphine subdermal implant by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Studies have shown that the combination of benzodiazepines and buprenorphine altered the usual ceiling effect on buprenorphine-induced respiratory depression, making the respiratory effects of buprenorphine appear similar to those 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.Serious - Use Alternative (1)buprenorphine subdermal implant and alprazolam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine transdermalSerious - Use Alternative (1)buprenorphine transdermal and alprazolam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine, long-acting injectionMonitor Closely (1)alprazolam 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.Serious - Use Alternative (1)buprenorphine, long-acting injection and alprazolam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebutabarbitalMonitor Closely (2)butabarbital 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.butalbitalMonitor Closely (2)butalbital 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.butorphanolMonitor Closely (1)alprazolam and butorphanol both increase sedation. Use Caution/Monitor.caffeineMonitor Closely (1)alprazolam increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.calcium/magnesium/potassium/sodium oxybatesSerious - Use Alternative (1)alprazolam, calcium/magnesium/potassium/sodium oxybates. 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.carbamazepineSerious - Use Alternative (1)carbamazepine will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.carbinoxamineMonitor Closely (1)carbinoxamine and alprazolam both increase sedation. Use Caution/Monitor.carisoprodolMonitor Closely (1)alprazolam and carisoprodol both increase sedation. Use Caution/Monitor.cenobamateMonitor Closely (2)cenobamate, alprazolam. Either increases effects of the other by sedation. Use Caution/Monitor. cenobamate 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.ceritinibSerious - Use Alternative (1)ceritinib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.chloral hydrateMonitor Closely (1)alprazolam and chloral hydrate both increase sedation. Use Caution/Monitor.chloramphenicolSerious - Use Alternative (1)chloramphenicol will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.chlordiazepoxideMonitor Closely (1)alprazolam and chlordiazepoxide both increase sedation. Use Caution/Monitor.chlorpheniramineMonitor Closely (1)chlorpheniramine and alprazolam both increase sedation. Use Caution/Monitor.chlorpromazineMonitor Closely (1)alprazolam and chlorpromazine both increase sedation. Use Caution/Monitor.chlorzoxazoneMonitor Closely (1)alprazolam and chlorzoxazone both increase sedation. Use Caution/Monitor.cimetidineSerious - Use Alternative (1)cimetidine will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.cinnarizineMonitor Closely (1)cinnarizine and alprazolam both increase sedation. Use Caution/Monitor.ciprofloxacinMinor (1)ciprofloxacin increases levels of alprazolam by decreasing metabolism. Minor/Significance Unknown.clarithromycinSerious - Use Alternative (1)clarithromycin will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.clemastineMonitor Closely (1)clemastine and alprazolam both increase sedation. Use Caution/Monitor.clobazamMonitor Closely (1)alprazolam, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).clomipramineMonitor Closely (1)alprazolam and clomipramine both increase sedation. Use Caution/Monitor.clonazepamMonitor Closely (1)alprazolam and clonazepam both increase sedation. Use Caution/Monitor.clonidineMonitor Closely (1)clonidine, alprazolam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.clorazepateMonitor Closely (1)alprazolam and clorazepate both increase sedation. Use Caution/Monitor.clozapineMonitor Closely (1)alprazolam and clozapine both increase sedation. Use Caution/Monitor.cobicistatContraindicated (1)cobicistat will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.codeineMonitor Closely (1)alprazolam and codeine both increase sedation. Use Caution/Monitor.conivaptanMonitor Closely (1)conivaptan will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cortisoneMonitor Closely (1)cortisone will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.crizotinibMonitor Closely (1)crizotinib 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.crofelemerMonitor Closely (1)crofelemer 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.cyclizineMonitor Closely (1)cyclizine and alprazolam both increase sedation. Use Caution/Monitor.cyclobenzaprineMonitor Closely (1)alprazolam and cyclobenzaprine both increase sedation. Use Caution/Monitor.cyclophosphamideMinor (1)cyclophosphamide will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.cyclosporineMonitor Closely (1)cyclosporine will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cyproheptadineMonitor Closely (1)cyproheptadine and alprazolam both increase sedation. Use Caution/Monitor.dabrafenibMonitor Closely (1)dabrafenib will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.dantroleneMonitor Closely (1)alprazolam and dantrolene both increase sedation. Use Caution/Monitor.daridorexantMonitor Closely (1)alprazolam 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. darifenacinMonitor Closely (1)darifenacin will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.darunavirMonitor Closely (1)darunavir will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.dasatinibMonitor Closely (1)dasatinib will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.deferasiroxMonitor Closely (1)deferasirox will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.desfluraneMonitor Closely (1)desflurane and alprazolam both increase sedation. Use Caution/Monitor.desipramineMonitor Closely (1)alprazolam and desipramine both increase sedation. Use Caution/Monitor.deutetrabenazineMonitor Closely (1)alprazolam and deutetrabenazine both increase sedation. Use Caution/Monitor.dexamethasoneMonitor Closely (1)dexamethasone will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.dexchlorpheniramineMonitor Closely (1)dexchlorpheniramine and alprazolam both increase sedation. Use Caution/Monitor.dexfenfluramineMonitor Closely (1)alprazolam increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dexmedetomidineMonitor Closely (1)alprazolam and dexmedetomidine both increase sedation. Use Caution/Monitor.dexmethylphenidateMonitor Closely (1)alprazolam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dextroamphetamineMonitor Closely (1)alprazolam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dextromoramideMonitor Closely (1)alprazolam and dextromoramide both increase sedation. Use Caution/Monitor.DHEA, herbalMonitor Closely (1)DHEA, herbal will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.diamorphineMonitor Closely (1)alprazolam and diamorphine both increase sedation. Use Caution/Monitor.diazepamMonitor Closely (1)alprazolam and diazepam both increase sedation. Use Caution/Monitor.diazepam intranasalMonitor Closely (1)diazepam intranasal, alprazolam. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.diethylpropionMonitor Closely (1)alprazolam increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.difelikefalinMonitor Closely (1)difelikefalin and alprazolam both increase sedation. Use Caution/Monitor.difenoxin hclMonitor Closely (1)alprazolam and difenoxin hcl both increase sedation. Use Caution/Monitor.digoxinMonitor Closely (1)alprazolam increases levels of digoxin by unknown mechanism. Use Caution/Monitor.diltiazemMonitor Closely (1)diltiazem 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.dimenhydrinateMonitor Closely (1)dimenhydrinate and alprazolam both increase