Can alprazolam be taken with trazodone? (3+ risks)

In this article, we will discuss whether alprazolam can be taken with trazodone. We will share the potential risks and benefits of taking alprazolam and trazodone together and other relevant information. 

Can alprazolam be taken with trazodone? 

Alprazolam can be taken with trazodone only if prescribed by the healthcare provider but they should not be taken at the same time. These medications may be prescribed together in some conditions.

It is advised to not take alprazolam and trazodone at the same time due to the amplified side effects. Their combined use can cause serious adverse effects if done without medical oversight. 

Alprazolam, the generic name for Xanax, is a psychoactive medication classified as benzodiazepine. Alprazolam binds to the receptor of a major inhibitory neurotransmitter called gamma-aminobutyric acid (GABA) (1). 

Alprazolam enhances the inhibitory effects of GABA on the central nervous system (CNS) and produces sedative and calming effects. It is commonly used to treat panic and anxiety disorders and off-label uses include insomnia and depression (1). 

Trazodone, an antidepressant, is categorized as a serotonin antagonist and reuptake inhibitor and works by increasing serotonin levels and blocking some serotonin, histamine (H1), and alpha-1 adrenergic receptors (2). 

Trazodone is primarily used to manage major depressive disorder (MDD) and is also utilized for sleep disturbances due to its sedative effects. It is also used for anxiety, Alzheimer’s disease, substance abuse, and fibromyalgia (2). 

Benzodiazepines can be prescribed with antidepressants to address symptoms like anxiety and enhance treatment outcomes (3). The research on the combined use of trazodone and alprazolam is limited. 

Taking alprazolam and trazodone can result in serious side effects if it is done without a prescription. Thus, these medications can only be taken together if your healthcare provider has advised it. 

What are the potential benefits of taking alprazolam with trazodone?

Alprazolam if prescribed with trazodone may help address the anxiety and panic symptoms that may co-occur with depression. The combination may provide quick relief from anxiety and enhanced compliance with the treatment with trazodone. 

Benzodiazepines like alprazolam are prescribed with antidepressants in the initial phase of treatment to provide quick relief from the symptoms (3).

Alprazolam may be prescribed to the patient during periods of high stress or panic while they are being treated with trazodone. Alprazolam is also used off-label for depression so it may enhance the antidepressant activity of trazodone.

Thus the potential benefits of their combination include relief from anxiety and panic and enhanced antidepressant effects. 

What are the risks of taking alprazolam with trazodone? 

Taking alprazolam with trazodone can result in adverse effects if done without medical oversight. Even if they are prescribed by the healthcare provider, the side effects can be amplified. The risks of taking alprazolam with trazodone include:

Increased sedation and drowsiness: 

Trazodone and alprazolam both act as sedatives and are used off-label to manage insomnia. As trazodone causes sedation, it is recommended to not take it in the morning. When taken at night, it can still make waking up hard for individuals. 

Alprazolam slows down the brain and causes sedation. Taking it with trazodone increases the sedative effects and makes an individual sleepy and drowsy. Therefore, their inappropriate use can be very risky. 

Increased risk of respiratory depression: 

Alprazolam is associated with the risk of respiratory depression and can make breathing shallower and slower than normal (1). The sedative effects of trazodone can further increase the risk of respiratory depression. 

Increased cognitive impairment: 

Taking alprazolam with trazodone can enhance their ability to impair judgment, thinking, memory, and motor skills. Driving and operating heavy machinery while taking these medications can be very risky and should be avoided. 

Enhanced side effects: 

Alprazolam and trazodone are both associated with their respective set of side effects and share several side effects. Taking alprazolam with trazodone increases the incidence of side effects and amplifies the shared side effects.

Side effects of alprazolam include (1): 

• drowsiness
• memory problems
• irritability
• dizziness
• diarrhea
• impaired balance and coordination
• constipation
• nausea
• tiredness
• vomiting
• sweating
• blurred vision
• dry mouth
• headache
• reduced alertness 
• difficulty in concentration
• changes in sex drive

Side effects of trazodone include (1):

• dizziness
• drowsiness
• fatigue
• dry mouth
• constipation
• orthostatic hypotension
• priapism 
• cognitive impairment
• reduced alertness
• impaired motor skills
• nightmares
• changes in sex drive
• acid reflux

Who should not take alprazolam and trazodone together? 

Elderly patients should avoid taking alprazolam with trazodone as it increases the risk of falls due to sedative effects. Benzodiazepines like alprazolam increase the risk of falls in the elderly when used either alone or with other drugs (4). 

Alprazolam should be avoided during pregnancy as it can cause fetal harm and it is a pregnancy category D drug (1). Trazodone is a pregnancy category C drug and should be used cautiously during pregnancy (2). 

Thus, taking alprazolam and trazodone may increase the risks of fetal harm. These medications should be used cautiously in the elderly and during pregnancy and should never be used together without medical oversight by these populations. 

How to take alprazolam with trazodone? 

Alprazolam might be prescribed with trazodone under some conditions to deal with anxiety or panic symptoms. However, it should never be used with trazodone without a prescription. 

Take the medications exactly as prescribed by the healthcare provider. Do not increase the dose of any medication by yourself. It is better to take alprazolam and trazodone at different times to avoid the enhanced sedative effects. 

Do not drink alcohol while taking these medications as it can increase the CNS depressant effects and risks of side effects. Alprazolam can be taken with or without food (1). Trazodone is recommended to be taken after meals (2). 

Alprazolam is not recommended to be used for long as the individual can develop dependence and has the potential for abuse. Alprazolam should not be discontinued abruptly as it can lead to withdrawal symptoms (1). 

Trazodone is also associated with withdrawal symptoms therefore it needs to be tapered before discontinuation. Therefore, if you experience adverse effects while taking the medications, contact your healthcare provider before discontinuation. 

In my perspective, alprazolam can be taken with trazodone only if prescribed by the healthcare provider. Research on their concomitant use is limited but alprazolam has been used with antidepressants to address different symptoms. 

Taking alprazolam with trazodone is risky therefore should not be done without medical oversight. The potential benefits of using them together as prescribed may include the reduction of anxiety and panic symptoms that may occur with depression. 

Using alprazolam with trazodone can increase the risk of sedation, drowsiness, cognitive impairment, and respiratory depression. Even if used under medical oversight, it can increase the incidence of side effects. 

Thus, taking alprazolam with trazodone is not highly recommended and they are not frequently prescribed together. If recommended, alprazolam and trazodone should be taken at different times. 

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