Benzodiazepines

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Also indexed as: Ativan, Bromazepam, Centrax, Chlordiazepoxide, Clonazepam, Clorazepate, Dalmane, Diastat, Diazepam, Dizac, Doral, Estazolam, Flunitrazepam, Flurazepam, Halazepam, Klonopin, Libritabs, Librium, Loprazolam, Lorazepam, Lormetazepam, Midazolam, Nitrazepam, Paxipam, Prazepam, ProSom, Quazepam, Restoril, Temazepam, Valium, Versed

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Introduction
Drugs in this category
Interactions summary
Vitamin interactions
Herb interactions
Food interactions
References
Benzodiazepines are a family of drugs used to treat insomnia, anxiety, panic attacks, muscle spasms, and seizure disorders. One benzodiazepine, midazolam, is used as a general anesthetic.

Summary of Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.

May Be Beneficial: Supportive interaction—Taking these supplements may support or otherwise help your medication work better. Vinpocetine

Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results. Alcohol

St. John's wort (alprazolam)

Depletion or interference None known

Side effect reduction/prevention None known

Reduced drug absorption/bioavailability None known

Interactions common to many, if not all, Benzodiazepines are described in this article. Interactions reported for only one or several drugs in this class may not be listed in this article. Some drugs listed in this article are linked to articles specific to that respective drug; please refer to those individual drug articles. The information in this article may not necessarily apply to drugs in this class for which no separate article exists. If you are taking a Benzodiazepine for which no separate article exists, talk with your doctor or pharmacist.

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions involving benzodiazepines in general are described on this page. For interactions involving a specific benzodiazepine, refer to the highlighted drugs listed below.

Alprazolam (Xanax®)
Chlordiazepoxide (Librium®, Libritabs®)
Clonazepam (Klonopin®)
Clorazepate Dipotassium (Tranxene®)
Diazepam (Valium®)
Estazolam (ProSom®)
Flunitrazepam (Rohypnol®)
Flurazepam (Dalmane®)
Lorazepam (Ativan®)
Midazolam (Versed®)
Oxazepam (Serax®)
Quazepam (Doral®)
Temazepam (Restoril®)
Triazolam (Halcion®)
Interactions with Dietary Supplements —
Vinpocetine
In a preliminary trial, an extract of periwinkle called vinpocetine was shown to produce minor improvements in short-term memory among people taking flunitrazepam, a benzodiazepine.1 Further study is needed to determine if vinpocetine would be a helpful adjunct to use of benzodiazepines.

Interactions with Herbs —
Kava (Piper methysticum)
Kava is an herb used to treat anxiety disorder. One individual who took a benzodiazepine (alprazolam) and kava together, along with two other medications (cimetidine and terazosin) was hospitalized in a lethargic and disoriented condition.2 Further research is needed to determine whether the combination of kava and benzodiazepines produces an adverse interaction. However, individuals should not take benzodiazepines and kava together unless supervised by a doctor.

St. John's wort (Hypericum perforatum)
In a study of healthy volunteers, administration of St. John's wort along with alprazolam decreased blood levels of alprazolam, compared with the levels when alprazolam was taken by itself.3 Individuals taking alprazolam should not take St. John's wort without supervision by a doctor.

Interactions with Foods and Other Compounds
Alcohol
Drinking alcoholic beverages while taking benzodiazepines may increase side effects, such as drowsiness, confusion, and dizziness;4 if taken in excess, this combination may result in death. Consequently, people taking benzodiazepines should avoid drinking alcohol.



1. Bhatti JZ, Hindmarch I. Vinpocetine effects on cognitive impairments produced by flunitrazepam. Int Clin Psychopharmacol 1987;2:325–31.

2. Almeida JC. Coma from the health food store: Interaction between kava and alprazolam. Ann Intern Med 1996;125:940–1.

3. Markowitz JS, Donovan JL, DeVane CL, et al. Effect of St John's wort on drug metabolism by induction of cytochrome P450 3A4 enzyme. JAMA 2003;290:1500–4.

4. Olin BR, ed. Central Nervous System Drugs, Psychotherapeutic Drugs, Antianxiety Agents, In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1255–69.