CBD and Alprazolam (e.g. Xanax, Tafil, Xanor)
David ReichUpdated:Key points at a glance:
CBD may inhibit the enzymes CYP3A4 and CYP2C19. Alprazolam is metabolised via CYP3A4. Using them together may slow the breakdown of alprazolam and increase sedative effects. Possible consequences can include tiredness, dizziness, drowsiness and impaired ability to drive or operate machinery. The potential risk may be higher in older adults, people with liver problems, those using higher amounts of CBD, or those also taking other sedative substances and alcohol. Systemic forms of CBD (such as oils or capsules) are generally considered more relevant in this context than topical products. Separating the timing of intake does not reliably avoid possible interactions. A doctor or other qualified healthcare professional should be consulted beforehand.
This article is intended for people who take alprazolam (e.g. Xanax, Tafil, Xanor) for anxiety or panic disorders and are also considering cannabidiol (CBD). It provides an overview of possible risks and interactions between CBD and alprazolam, what to pay attention to in everyday life, and how to discuss the topic in a structured way with your doctor.
How do CBD and alprazolam work?
CBD in brief
CBD (cannabidiol) is a naturally occurring compound from the cannabis plant. It interacts with the endocannabinoid system, which is associated with processes such as mood, sleep and stress responses. CBD does not produce a “high”, but it may cause drowsiness. It can inhibit certain liver enzymes (especially CYP3A4 and CYP2C19) and may therefore influence how some prescription medicines are metabolised in the body. CBD is most commonly bought and taken in oil form. CBD is not psychoactive, meaning it does not cause feelings of being “high”. You can find more information here about how CBD acts in the body
CBD is often described as having relaxing properties, does not cause a high and can inhibit liver enzymes such as CYP3A4 and CYP2C19. As a result, interactions with other medicines are possible.
Alprazolam in brief
Alprazolam belongs to the benzodiazepine group of medicines. It enhances the effect of the messenger substance GABA in the brain and is used for its anxiety-relieving and calming properties. In the liver, alprazolam is mainly broken down by the enzyme CYP3A4. Anything that inhibits CYP3A4 (e.g. certain medicines, grapefruit – and potentially CBD) can slow this breakdown.
Possible interactions between CBD and alprazolam
There is evidence that CBD can inhibit CYP3A4 and CYP2C19 in vitro and, in some circumstances, in a clinically relevant way. As alprazolam is primarily metabolised via CYP3A4, a pharmacokinetic interaction is considered plausible: the breakdown may be slower, which could lead to higher blood levels and an increased likelihood of side effects. In addition, CBD and alprazolam may both contribute to central nervous system depression, which can favour drowsiness, light-headedness and reduced ability to drive.
Pharmacokinetic CBD–alprazolam interaction: CYP3A4 and CBD metabolism
CBD may inhibit CYP3A4 and CYP2C19. In theory, this can slow the breakdown of alprazolam – with potentially higher blood levels and side effects such as sleepiness or confusion. This is one of the reasons why CBD drug interactions, particularly via liver enzymes like CYP3A4, are taken seriously in clinical practice.
Pharmacodynamic interaction: additive sedation from CBD and alprazolam
CBD and alprazolam both have a dampening effect on the central nervous system. Taken together, this may more often lead to tiredness, light-headedness, dizziness, reduced cognitive performance and an increased risk of falls. This is particularly relevant at the start of treatment, when CBD doses are being increased, or when alprazolam dosing is adjusted.
Higher-risk groups for CBD and alprazolam combination
- Older people and those with impaired liver function
- People taking several medicines, especially other substances that depress the central nervous system (e.g. alcohol, sedating antihistamines, opioids, Z‑drugs/sleeping tablets)
- People using higher CBD intakes or systemic forms with higher exposure (e.g. oral oils, capsules, strong edibles, inhaled/vaped forms)
- People who are new to using CBD and do not yet know how they react
Forms of CBD: does the way you take it matter?
- Systemic forms: oils/drops, capsules, edibles and vape products reach the bloodstream and are more relevant for potential CBD–alprazolam interactions.
- Topical products (e.g. creams/balms): usually lower systemic absorption, so interaction risk is generally lower, although data are limited.
You can find our article on CBD interactions here
CBD may slow the breakdown of alprazolam via CYP3A4/CYP2C19 and can increase drowsiness. Extra caution is advisable if you also use other sedatives, drink alcohol or have liver problems.
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Overview of possible side effects
CBD
CBD is generally considered to be well tolerated. Commonly reported effects include tiredness/drowsiness, dry mouth, changes in appetite and mild gastrointestinal discomfort. In some cases, increases in liver enzymes have been observed, particularly at higher intakes or when taken together with other medicines that are also metabolised in the liver. Because CBD can affect drug metabolism, CBD and prescription medicines should be discussed with a doctor in advance if you take medicines regularly.
Alprazolam
Commonly reported side effects include sleepiness, light-headedness, dizziness, coordination problems and memory impairment. Paradoxical reactions (restlessness/irritability) may occur, especially in older people. With longer-term use, there is a risk of tolerance, dependence and withdrawal symptoms. In general, the ability to drive may be impaired under alprazolam. When combined with CBD, this risk may increase due to additive sedation.
Practical considerations: using CBD and alprazolam more safely
Checklist before and during combined use
- Prepare a complete list of all medicines and products you use (including over‑the‑counter products, supplements and typical alcohol consumption) and discuss CBD use with a doctor before starting.
- Ask your doctor about appropriate CBD amounts, timing of intake alongside alprazolam, and whether liver function tests are advisable for you.
- Begin with a low amount of CBD and increase gradually if agreed with your doctor; note any changes (tiredness, light-headedness, concentration, sleep, daily activities).
- Avoid additional substances that depress the central nervous system, such as alcohol, sedating antihistamines, opioids and Z‑drugs, unless specifically agreed with your doctor.
- Do not drive or operate machinery until you can reliably assess how you react to the combination of CBD and alprazolam.
Warning signs
- Marked sleepiness, pronounced light-headedness or confusion
- Breathing difficulties or noticeably slowed breathing
- Falls, balance problems or double vision
- Unusual mood swings or paradoxical agitation
If you notice these signs, seek medical advice promptly; if there are breathing difficulties, call the emergency services.
Before combining CBD and alprazolam, clarify the plan with your doctor, start low, increase slowly and monitor yourself carefully. If you experience severe tiredness, confusion, falls or breathing problems, seek medical help immediately.
Research situation & expert views on CBD and alprazolam
Direct human studies on the combination of CBD and alprazolam are limited. Current caution is based on: (a) data showing inhibition of CYP3A4/CYP2C19 by CBD (in some cases clinically relevant), (b) analogous data with other CYP3A4 substrates (e.g. midazolam) and (c) experience with CYP2C19 substrates (e.g. clobazam). Professional bodies and medicines regulators therefore emphasise individual medical assessment, cautious dosing strategies and close monitoring when CBD is used with benzodiazepines.
What is documented? CBD can inhibit certain CYP enzymes and can have sedating effects. What appears plausible in practice for CBD and alprazolam? Increased alprazolam levels due to altered metabolism and additional drowsiness or impaired alertness.
There are few direct studies on CBD plus alprazolam. Caution is mainly based on known CYP3A4/CYP2C19 inhibition by CBD, its potential to affect drug metabolism and experience with similar medicines.
What do experts say?
Most medical experts see a need for further clarification, but highlight the potential relevance of CYP3A4/CYP2C19 inhibition by CBD and possible additive sedation when CBD is combined with benzodiazepines such as alprazolam. The combination is not automatically contraindicated, but requires cautious, medically supervised use and careful monitoring, particularly in people taking other medicines or those with liver problems.
Conclusion
CBD is described by many users as having a calming influence and is generally considered to be well tolerated. When used together with alprazolam, however, possible interactions should be taken into account: CBD can inhibit CYP3A4/CYP2C19 and, in combination with alprazolam, may enhance sedative effects and alter alprazolam metabolism. Discuss use with your doctor beforehand, start with a low amount, increase slowly and do not drive until you are confident about how you personally react. Watch out for warning signs and adjust your CBD intake in consultation with a healthcare professional.
Disclaimer: This article is for information purposes only and does not replace medical advice. Do not change medicines or dosages without consulting your doctor. No claims are made regarding the treatment or cure of illnesses.