Mixing alcohol and Xanax (benzodiazepines)?

Dear Alice,

Is it ok to drink alcohol while taking Xanax?

Dear Reader,

Alprazolam (the generic term for Xanax) and alcohol aren't exactly oil and water — but mixing the two can have some serious consequences. The short answer to your question is that taking alprazolam with alcohol could increase the risk for alcohol poisoning and cardiac or respiratory arrest. But, it may be helpful to know a little bit more about how alcohol and alprazolam affect the body in order to make a fully informed decision, so read on to find out more.

Alprazolam is a commonly prescribed psychoactive drug that belongs to a family of compounds called benzodiazepines. Also known as “benzos,” these drugs are typically prescribed to manage the symptoms of general anxiety or panic disorders by calming and slowing down the central nervous system. While generally considered safe, using these medications carry some risks, including physical and psychological dependency from regular or heavy use that can result in withdrawal symptoms similar to alcohol. While there are risks, alprazolam is rarely fatal when used as directed and when treatment is monitored by an appropriate health care provider. It may help to keep in mind that folks might be prescribed different dosages and different formulations depending on the type and severity of the anxiety symptoms experienced by a patient. For example, in addition to its typical formulation, alprazolam can be prescribed in an extended release version that remains at a higher concentration in the blood for a much longer period of time.

So, what happens when you combine these drugs? There’s no way to know exactly how taking alprazolam while drinking will affect each person individually, but researchers do know this: benzodiazepines and alcohol are both “downers” that depress the central nervous system and impart sedative and muscle relaxant effects (e.g., drowsiness, light-headedness, headache, fatigue, and impaired coordination). And these effects become additive when they are consumed together, meaning using both at the same time can increase the depressant effects. According to the National Institute on Alcohol Abuse and Alcoholism, other reactions to mixing alcohol with anxiety medications could include increased risk for overdose, difficulty breathing, and impaired memory. Because of these possible risks, it’s best to have a conversation with a health care provider about whether it’s safe to use prescribed alprazolam while consuming any amount of alcohol. If alprazolam is obtained outside of a provider’s care for recreational use, it’s even more challenging to anticipate the effects of mixing them with alcohol, and doing so is not recommended. Additionally, the impact of benzodiazepines and alcohol on individuals varies because of different variables such as:

  • Body weight
  • Age (older individuals have a higher risk of serious reactions)
  • The amount of food eaten before or while drinking
  • How quickly a person is consuming alcohol
  • The dose of alprazolam consumed and the volume of alcohol consumed
  • An individual’s kidney and liver health (impaired kidneys or a damaged liver can slow down metabolism)

Also, tolerance (the need to consume a higher dose to achieve the desired feelings) to benzodiazepines or alcohol may lessen the sedative effects whether the substances are consumed alone or concurrently. This may make it more difficult for a user to know when they've had too much or either alcohol or benzodiazepines. What’s more, a person’s mood is another factor that can influence the way an individual may react, though it won't impact the physiological effects.

If you or someone you know is having difficulty managing substance use, it might be a good idea to make an appointment with a health care provider who can give you more information or make a referral to additional resources. If you’d like more information on medications or support for managing anxiety, stress, consider talking with a mental health professional.

Keep well,

Last updated Jul 08, 2016
Originally published May 24, 2013