Is it safe to take Xanax with beta-blockers? (+3 tips)
By
Dr Milena Locci de Oliveira (PhD)
Author bio
Dr Milena Locci de Oliveira is a Pharmacist and Doctor of Philosophy in Sciences from the University of São Paulo (USP). She has experience in microbiology, analytical toxicology, and clinical pharmacokinetics. She writes and reviews content on these topics.
Dr Milena’s Highlights:
-PhD in Sciences, University of São Paulo, Brazil, 2019.
-University College London (UCL) – Semester of remote collaboration in the areas of Pharmacometrics and Population Pharmacokinetics, 2018.
-Bachelor in Biochemical Pharmacy, University of São Paulo, Brazil, 2013.
“Science can be translated, and it is essential that everyone has access to quality information to make informed decisions” – Dr Milena Oliveira, PhD.
Professional Experience:
With a decade-long career as a researcher, Dr Milena has amassed extensive experience in conducting research projects in microbiology, analytical toxicology, and clinical pharmacokinetics.
Her expertise also extends to the preparation of technical and scientific reports, literature reviews, data analysis, and scientific communication, both oral and written.
Dr Milena has served as a Clinical Pharmacist, providing expert supervision and guidance to teams during the challenging times of the COVID-19 pandemic, particularly in the ICUs of two reference hospitals for patient hospitalization.
In her most recent role, Dr Milena worked on the implementation of the deliberatives of the São Paulo State Government Pharmaceutical Assistance Coordination. These decisions were aimed at ensuring medication access within the Unified Health System.
A widely multidisciplinary background enabled Dr Milena to become a professional capable of integrating scientific knowledge into private initiatives, education, and healthcare, delivering consistent services in patient safety and population health.
Professional Memberships & Affiliations:
Dr Milena Oliveira is a member of the Regional Council of Pharmacy of the State of São Paulo, Brazil.
Education:
-PhD in Sciences, University of São Paulo, Brazil, 2019.
-University College London (UCL) – Semester of remote collaboration, 2018.
-Bachelor in Biochemical Pharmacy, University of São Paulo, Brazil, 2013.
Relevant Published Work & Citations:
Oliveira ML de, Rocha A, Nardotto GHB, Pippa LF, Simões BP, Lanchote VL. Analysis of daunorubicin and its metabolite daunorubicinol in plasma and urine with application in the evaluation of total, renal and metabolic formation clearances in patients with acute myeloid leukemia. Journal of Pharmaceutical and Biomedical Analysis. Nov 2020. 191:113-124.
Abstracts. CPT: Pharmacometrics & Systems Pharmacology. 2020 Nov; 9 (S1).
Pippa LF, Oliveira ML de, Rocha A, de Andrade JM, Lanchote VL. Total, renal and hepatic clearances of doxorubicin and formation clearance of doxorubicinol in patients with breast cancer: Estimation of doxorubicin hepatic extraction ratio. Journal of Pharmaceutical and Biomedical Analysis. 2020 Jun 5; 185:113-231.
Godoy ALPC, De Jesus C, De Oliveira ML, Rocha A, Pereira MPM, Larangeira DF, Lanchote VL, Barrouin-Melo SM. Determination of Allopurinol and Oxypurinol in Dogs Plasma by High-Performance Liquid Chromatography with an Ultraviolet Detector: Application for Pharmacokinetic Studies. J Chromatogr Sep Tech. 2017; 8 (4).
Clímaco EC, Oliveira ML de, Pitondo-Silva A, Oliveira MG, Medeiros M, Lincopan N, et al. Clonal complexes 104, 109 and 113 playing a major role in the dissemination of OXA-carbapenemase-producing Acinetobacter baumannii in Southeast Brazil. Infection, Genetics and Evolution. 2013 Oct;19:127–33.
Conference Papers:
Oliveira, M. L.; NARDOTTO, G. H. B.; PIPPA, L. F.; ROCHA, A.; SIMOES, B. P.; LANCHOTE, V. L. . Daunorubicin metabolism and urinary excretion in patients with acute myeloid leukemia. In: 84th Annual Meeting of the German Society for Experimental and Clinical Pharmacology and Toxicology (DGPT) and the 20th Annual Meeting of the Association of the Clinical Pharmacology Germany (VKliPha), 2018, Göttingen. Naunyn-Schmiedeberg’s Arch Pharmacol, 2018. v. 391. p. S76-S76.
Oliveira, M. L.; NARDOTTO, G. H. B. ; ROCHA, A. ; SIMOES, B. P. ; LANCHOTE, V. L. . The low contribution of urinary excretion in the elimination of daunorubicin and its metabolite daunorubicinol in patients with acute myeloid leukemia. In: 49th Brazilian Congress of Pharmacology and Experimental Therapeutics., 2017, Ribeirão Preto. Livro de Resumos, 2017. p. 64-64.
Oliveira, M. L.; PIPPA, L. F. ; ROCHA, A. ; SIMOES, B. P. ; LANCHOTE, V. L. . Quantification of daunorubicin and its metabolite daunorubicinol in human plasma by LC-MS/MS. In: I International Meeting of Environmental Health and Toxicology (IMEHTOX), 2016, Ribeirão Preto. Livro de Resumos, 2016.
Oliveira, M. L.; Clímaco, E.C. ; OLIVEIRA, M. G. ; Lincopan, N. ; Darini A.L.C. . PFGE typing of Carbapenem-Resistant Acinetobacter baumannii isolated from different University Hospitals. In: V International Postgraduate and Research Symposium, 2012.
Clímaco, E.C. ; SILVA, A. P. ; Oliveira, M. L. ; OLIVEIRA, M. G. ; Lincopan, N. ; Darini A.L.C. Relação clonal entre linhagens de Acinetobacter baumannii produtoras de carbapenemases da família OXA em quatro hospitais no Brasil. In: XXI Latin American Congress of Microbiology, 2012, Santos. XXI Latin American Congress of Microbiology, 2012.
Oliveira, M. L.; Clímaco, E.C. ; OLIVEIRA, M. G. ; Darini A.L.C. . Dissemintion of OXA carbapenemases genes in carbapenem-resistant Acinetobacter baumannii in University Hospital of Juiz de Fora, MG. In: 8th CIFARP – International Congress of Pharmaceutical Sciences, 2011, Ribeirão Preto.
Clímaco, E.C. ; Oliveira, M. L. ; OLIVEIRA, M. G. ; Darini A.L.C. . Avaliação do sequenciamento parcial do gene rpoB e de seus flanqueadores para identificação de espécies de Acinetobacter na rotina laroratorial. In: 2° International Symposium on Clinical Microbiology, 2010, Florianópolis.
You can view some of Dr Milena’s work below and links to her professional profile.
Linkedin: https://www.linkedin.com/in/dra-milena-locci-de-oliveira-28986042/?locale=en_US
ResearchGate: https://www.researchgate.net/profile/Milena-Oliveira-6
Escavador: https://www.escavador.com/sobre/5394254/milena-locci-de-oliveira
Lattes: https://buscatextual.cnpq.br/buscatextual/busca.do
Scopus: https://www.scopus.com/authid/detail.uri?authorId=57199779361
Scholar: https://scholar.google.com/citations?view_op=list_works&hl=pt-BR&user=1YUBDIQAAAAJ
In this article, an important question will be answered: “Is Xanax safe to be taken with beta blockers?” Besides the risk factors for concurrent anxiety and hypertension, the ways of their management and what are the side effects of taking Xanax with beta-blockers
Is it safe to take Xanax with beta-blockers?
It isn’t safe to take Xanax with beta-blockers. However, if prescribed by your healthcare physician, they can still be taken (1). Both Xanax and beta-blockers, such as propranolol, are prescribed for the treatment of anxiety, though they work with different mechanisms.
Xanax (alprazolam) is prescribed widely for the treatment of generalized anxiety and panic disorders (2). It can be used safely if properly prescribed and dose-adjusted; otherwise, there is a great risk of addiction (2). It belongs to the benzodiazepines class, which works by enhancing the gamma-aminobutyric acid neurotransmitters in the brain, causing a calming effect.
Beta-blockers, commonly known as beta-adrenergic blocking agents, work on beta-adrenergic receptors in the heart and blood vessels. They act by lowering the stress hormones, such as adrenaline, resulting in a reduction in heart rate, blood pressure, and cardiac output. In some cases, they are employed mainly in the treatment of generalized anxiety (3).
The use of beta blockers in anxiety cases is restricted to those patients who haven’t responded to the therapy with benzodiazepines adequately (4). Combination therapy between Xanax and beta blockers is highly restricted and limited to acute anxiety cases, not long-term therapy regimens (5).
What are the side effects of taking Xanax with beta blockers?
Some adverse effects must be taken into consideration, making concurrent therapy with Xanax and beta-blockers not recommended. They are summarized as follows:
- Beta-blockers are drugs that effectively lower blood pressure. When it is combined with Xanax, which is a sedative drug, there might be a synergestic effect that leads to hypotension.
- The sedative effects of Xanax may be increased when taken with beta blockers, leading to impaired cognitive and motor functions.
- Xanax and beta-blockers can both depress the central nervous system. Combined, this effect is exacerbated, raising the risk of respiratory failure.
- The side effects of both classes include dizziness, fatigue, and gastrointestinal problems. These adverse effects become more pronounced when both drugs are taken together.
Are there risk factors for concurrent anxiety and hypertension?
When deciding whether to prescribe Xanax for an anxious person, it is essential to weigh the benefit-risk factors before recommending it.
Some risk factors may lead to simultaneous anxiety and hypertension, some of which include sex, lifestyle, and environment (6).
It was found that anxiety raises the possibility of acquiring hypertension due to its influence on an unhealthy lifestyle such as smoking, depression, a sedentary lifestyle, and being overweight (6).
How do you manage anxiety and hypertension concurrently?
Depression and anxiety are frequently coexisting conditions, so their management is critical. It was found that there is an increased risk of hypertension in people suffering from anxiety (7). Men with anxiety disorders showed a higher prevalence of hypertension than women (7).
Research has shown that for people suffering from both hypertension and anxiety problems, it is better to take a combination therapy of an antihypertensive and an antidepressant (8). This showed more beneficial results than taking antihypertensive therapy alone (8).
When short-term therapy for anxiety is required, benzodiazepines (Xanax) are considered the drug of choice better than psychological therapies (9). This is because other classes of antidepressants have a longer onset of action. In addition, there is a risk of tolerance for benzodiazepines if the therapy period exceeds 2 weeks, so they must be replaced with other classes of antidepressants.
Conclusion
It is concluded that a combined intake of both Xanax and beta-blockers is not recommended unless it is prescribed by an expert health therapist. They can possess synergistic effects, increasing the side effects of both drugs and leading to serious complications. Continuous communication with your doctor is a must to avoid any problems that may arise during therapy with both drugs.
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References
1.-
Hayes P.E., Schulz S.C. 1987. Beta-blockers in anxiety disorders, Journal of Affective Disorders, 13,2, 119-130, https://doi.org/10.1016/0165-0327(87)90017-6. https://www.sciencedirect.com/science/article/pii/0165032787900176
2.-
Ait-Daoud N, Hamby AS, Sharma S, Blevins D. A. 2018 Jan/Feb. Review of Alprazolam Use, Misuse, and Withdrawal. J Addict Med. ;12(1):4-10. doi: 10.1097/ADM.0000000000000350. PMID: 28777203; PMCID: PMC5846112. https://pubmed.ncbi.nlm.nih.gov/28777203/
3.-
Peet M. The treatment of anxiety with beta-blocking drugs. Postgrad Med J. 1988;64 Suppl 2:45-9. PMID: 2905798. https://pubmed.ncbi.nlm.nih.gov/2905798/
4.-
Davidson JR. Pharmacotherapy of social anxiety disorder: what does the evidence tell us? J Clin Psychiatry. 2006;67 Suppl 12:20-6. PMID: 17092192.https://pubmed.ncbi.nlm.nih.gov/17092192/
5.-
Shell WE, Swan HJ. 1986 Nov.Treatment of silent myocardial ischemia with transdermal nitroglycerin added to beta-blockers and alprazolam. Cardiol Clin. ;4(4):697-704. PMID: 2877735. https://pubmed.ncbi.nlm.nih.gov/2877735/
6.-
T. Qiu, Z. Jiang, X. Chen, Y. Dai, H. Zhao,2023. Comorbidity of Anxiety and Hypertension: Common Risk Factors and Potential Mechanisms. International Journal of Hypertension 2023, 2023, 9619388. DOI: 10.1155/2023/9619388. https://www.hindawi.com/journals/ijhy/2023/9619388/
7.-
En-Liang Wu, I-Chia Chien, Ching-Heng Lin, 2014. Increased risk of hypertension in patients with anxiety disorders: A population-based study, Journal of Psychosomatic Research, 77, 6, 522-527, https://www.sciencedirect.com/science/article/pii/S0022399914003584?via%3Dihub
8.-
Versteeg SJ, Stefanatou A. 2022. Hypertension and Anxiety: Comorbidity, Treatment, and Access to Resources. Cardiol Cardiovasc Res.;1(1):1-6. https://acg150.acg.edu/wp-content/uploads/2023/03/hypertension-and-anxiety-comorbidity-treatment-and-access-to-resources.pdf
9.-
Salzman C. 1991 Feb.https://pubmed.ncbi.nlm.nih.gov/1987812/The APA Task Force report on benzodiazepine dependence, toxicity, and abuse. Am J Psychiatry. ;148(2):151-2. doi: 10.1176/ajp.148.2.151. PMID: 1987812.
