Last reviewed by Editorial Team on August 28th, 2018.
What is Xanax? What are Xanax indications?
Xanax is a Brand name for a drug containing short-acting benzodiazepine drug named alprazolam as an active ingredient. Alprazolam works by affecting chemicals known as neurotransmitters in the brain that may be unbalanced in those with different types of anxiety disorder.
Xanax indications are: panic disorders with or without agoraphobia, generalized anxiety disorder and anxiety linked with depression. It is available on the market in the form of immediate release tablet in doses of: 0.25, 1, 2 and 5 mg and in form of extended release tablet, named as Xanax XR in doses of 3 and 5 mg.
What is Suboxone? What are Suboxone indications?
Suboxone is a Brand name for a medicine that contains the combination of buprenorphine and naloxone. Buprenorphine is opioid analgesic that is used for the treatment of opioid dependence and moderate to severe pain.
Naloxone is opioid antagonist drug that blocks the effects of opioid drugs, including pain relief or feelings of well-being that can lead to opioid abuse. It is available in the form of sublingual tablets in doses of 2/0.5 mg and 8/2 mg.
How Xanax and Suboxone work in the body?
Alprazolam which is the active ingredient of Xanax binds to benzodiazepine BNZ-1 receptors, responsible for sleep indiuction and benzodiazepine BNZ-2 receptors responsible for anticonvulsant activity, motor coordination and memory functions.
BNZ1 and BNZ2 receptors are coupled GABAA receptors, and when alprazolam binds to them it increases the inhibitory effects of GABA neurotransmitter by increasing the affinity of GABA for its binding sites. When GABA binds to its receptors it opens the chloride channel, which results in a hyperpolarization of a cell membrane and prevention of further cell excitation.
Suboxone is a combination of two active ingredients: Buprenorphine and Naloxone. Buprenorphine is an opioid drug which is derivative from tebaine that works as a partial agonist at mu and kappa opioid receptors and as an antagonist of delta opioid receptors.
It is indicated for the treatment of moderate to severe pain, peri-operative analgesia, and opioid dependence. Naloxone is a specific antagonist of opioid receptors that has no agonist activity. It is a competitive antagonist of mu, delta, and kappa opioid receptors.
Is it safe to take xanax and suboxone together?
Using buprenorphine together with alprazolam which is drug that can cause central nervous system depression may lead to serious side effects such as coma, respiratory depression and even death.
Reported cases of this interaction have primarily been occurred at the beginning of suboxone and buprenorphine maintenance therapy of opiate addiction, and in most cases, but not all, involved misuse or abuse of suboxone including intravenous self-injection.
The exact mechanism of interaction is not known, but preclinical studies suggest that benzodiazepines such as alprazolam can potentiate buprenorphine-induced respiratory depression and reduced respiratory effects of suboxone appear to be similar to those of full opioid agonists for example morphine’s.
Patients should never drink alcohol while taking some of these drugs or take these medicines on their own, without their doctor’s approval, and should not exceed the doses or frequency. Also, they have to avoid driving or operating hazardous machinery while there on these drugs. They should not stop using any of these drugs on their own without first talking to their doctor.
If these products are taken together, there is a higher chance to cause following side effects:
- Headache (28-36.4%)
- Drowsiness (41%)
- Withdrawal syndrome (24-25.2%)
- Insomnia (14-23%)
- Pain (22.4%)
- Nausea (7-15%)
- Hyperhidrosis (14%)
- Asthenia (6.5-14%)
- Constipation (5-12.1%)
- Abdominal pain (11.2%)
- Diarrhea (10%)
- Vasodilation or peripheral edema (9.3%)
- Chills (6-7.5%)
- Vomiting (4-7.5%)
- Depression (10-15%)
- Dry mouth (10-15%)
- Tachycardia (5-10%)
- Confusion (5-10%)
- Insomnia (5-10%)
- Nausea/vomiting (5-10%)
- Blurred vision (5-10%)
- Nasal congestion (5-10%)
- Hypotension (1-5%)
- Syncope (1-5%)
- Akathisia (1-5%)
- Dizziness (1-5%)
- Increased salivation (1-5%)
- Nervousness (1-5%)
- Tremor (1-5%)
- Weight change (1-5%)
Suboxone and Xanax interaction with other drugs
Suboxone should never been taken together with following medications:
Suboxone may also interact with next medications:
- antihistamines for allergy, cough and cold
- barbiturates like phenobarbital
- antibiotics like erythromycin and clarithromycin
- medicines for depression, anxiety, or psychotic disturbances
- general anesthetics
- sleep aids
- medicines used to treat HIV infection or AIDS like ritonavir, saquinavir, and indinavir
- muscle relaxants
- medicines for fungal infections like fluconazole, itraconazole, ketoconazole, and voriconazole
- narcotic medicines (opiates) for pain
- phenothiazines like chlorpromazine, mesoridazine, prochlorperazine, thioridazine
- rifampin or rifampicin
Xanax may interact with next medicines:
- Prilosec (omeprazole)
- Tums or Rolaids
- Lortab and Vicodin
- Benadryl and its generic forms
- Diabetic Tussin Night Time
- Contac Day and Night Cold and Flu
- Melatonin supplements
- Sleep Ease
- Halcion (also a benzodiazepine)
Xanax like other benzodiazepines can become habit-forming, even when it is taken in recommendable doses for short periods of time. Patients who take Xanax can often develop a tolerance to this drug and usually need to increase the doses of the drug for it to still be effective.
Many patients may experience withdrawal symptoms when they stop taking Xanax, such as:
Xanax should be discontinued only under supervision of a physician with gradually reduced amounts of medication to minimize withdrawal symptoms.
Suboxone during pregnancy
Patients who are considering the use of Suboxone for management of opiate addiction during pregnancy, the first step is to speak with their doctor. Doctor will give information about therapy options and for all other that is need in order to protect child from the harms that can be caused by ongoing drug abuse or addiction.
Animal studies have failed to reveal evidence of buprenorphine teratogenicity; however, use of buprenorphine has been linked with fetotoxicity and difficult parturition, including pre- and postimplantation loss and decreased postnatal survival in animals. There are no controlled data in human pregnancy. FDA pregnancy category is C.
Naloxone administration during organogenesis in mice and rats showed no evidence of embryotoxicity or teratogenicity. This drug does cross the placenta and thus may have influence in withdrawal in the fetus. There are no adequate and well controlled studies in pregnant women. FDA pregnancy category is C.