May 23 2022



Active ingredient: alprazolam

Overall, there may be a sum of nervous system depressant effects when a benzodiazepine is administered concurrently with any other substance that depresses the central nervous system, including alcohol.

Thus, the nervous system depressant effects produced by alprazolam may be potentiated by alcohol, raising the risk of apnea, so not recommended for concomitant use.

During treatment with alprazolam, patients should be encouraged to avoid consuming alcohol or CNS depressant drugs.

Study investigated the interaction between ethanol and high doses of alprazolam. Production of 4-hydroxy derivative is inhibited in part by a higher dose of ethanol, but not alpha-OH derivative. These results show that the production of 4-OH-alprazolam is weakly inhibited by ethanol, and can be reached toxic levels of alprazolamr by simultaneous administration of high dose ethanol[ 1]. However, other studies suggest that alcohol does not affect the removal of alprazolam[2].

A comparative study versus placebo on behavioral effects of buspirone, alprazolam, and alcohol in 13 volunteers showed that only the combination of alprazolam and ethanol produced cognitive and psychomotor performance impairment of the patients, while the combination of alcohol with buspirone showed only mild sedative effects[3].

Combining alprazolam and alcohol increases aggressive behavior more than would have been predicted from the sum of the individual effects of the two substances, which confirms the indicated by prior observations about uncontrolled behavior[4][5]. Another observed effect is the prolongation of reaction time and increased tremor in the co-administration of both substances[6].

In another trial, the administration of 2 mg of alprazolam and alcohol resulted in an impairment of psychomotor performance, cognitive information processing and verbal and nonverbal memory of relatively long duration[7].

References

1: Tanaka E, Nakamura T, Terada M, Shinozuka T, Honda K. Metabolic interaction Between ethanol, high-dose alprazolam and its two main metabolites using human liver microsomes in vitro. J Forensic Leg Med 2007 Aug, 14 (6) :348-51.
2: Greenblatt DJ, Wright CE. Clinical pharmacokinetics of alprazolam. Therapeutic Implications. Clin Pharmacokinet. 1993 Jun; 24 (6) :453-71.
3: Rush CR, Griffiths RR. Acute participant-rated and behavioral effects of alprazolam and buspirone, alone and in combination with ethanol, in Normal volunteers. Exp Clin Psychopharmacol. 1997 Feb; 5 (1) :28-38.
4: Bond AJ, Silveira JC. The combination of alprazolam and alcohol, on behavioral aggression. J Stud Alcohol Suppl. 1993 Sep; 11:30-9.
5: HB Terrell. Behavioral dyscontrol Associated with combined use of alprazolam and ethanol. Am J Psychiatry. 1988 Oct; 145 (10): 1313.
6: Bond AJ, Silveira JC, Lader MH. The effects of alprazolam alone and combined Alcohol on integrative center with activity. Eur J Clin Pharmacol. 1992, 42 (5) :495-8.
. 7: Linnoila M, Stapleton JM, Lister R, Moss H, Lane E, Granger A, Eckardt MJ. Effects of single doses of alprazolam and diazepam, alone and in combination with ethanol on psychomotor and cognitive performance and on autonomic nervous system reactivity in healthy volunteers. Eur J Clin Pharmacol. 1990, 39 (1) :21-8.