MajorBenzodiazepines. Short-to-medium-acting anxiolytics×Antiepileptics (other)
Updated · Methodology
Mechanism
Additive CNS depression and sedation. No direct pharmacokinetic interaction – levetiracetam is not CYP-metabolised.
Symptoms
Drowsiness, slowed thinking and reactions, impaired coordination. With marked depression: slow, shallow breathing and confusion, up to coma (alprazolam SmPC). In older patients, sedation and muscle weakness increase the risk of falls (alprazolam SmPC).
Management
The alprazolam SmPC requires limiting the dose and duration of co-administration with antiepileptics, which include levetiracetam (alprazolam SmPC; alprazolam label of the US Food and Drug Administration, FDA). Use alprazolam at the lowest effective dose for the shortest time, no longer than 2–4 weeks; in older patients, start with 0.25 mg two or three times a day and use caution because of sedation, muscle weakness and the risk of falls (alprazolam SmPC). Advise the patient not to drive or operate machinery while taking alprazolam (alprazolam FDA label).
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Xanax (alprazolam) tablets prescribing information (Pharmacia & Upjohn) (2023)– FDA label, DailyMed setid 388e249d-b9b6-44c3-9f8f-880eced0239f, revised 01/2023, section 7.1 (CNS Depressants) and 17
- AEMPS: Ficha técnica: Alprazolam (Trankimazin 1 mg) (nº registro 56025), secciones 4.2, 4.4 y 4.5 (2025)– AEMPS, CIMA, nº registro 56025, revisión 03/2025, secciones 4.2, 4.4 y 4.5