See also Warning and How to Use sections.
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Some products that may interact with this drug include: clozapine, fluvoxamine, orlistat, sodium oxybate.
The risk of serious side effects (such as slow/shallow breathing, severe drowsiness/dizziness) may be increased if this medication is taken with other products that may also cause drowsiness or breathing problems. Tell your doctor or pharmacist if you are taking other products such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), other drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).
Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.
This medication may interfere with certain lab tests, possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.
Kava (Piper methysticum) is an herb used to treat anxiety disorder. One individual who took a benzodiazepine (alprazolam) and kava together, along with two other medications (cimetidine and terazosin) was hospitalized in a lethargic and disoriented condition.2 Further research is needed to determine whether the combination of kava and benzodiazepines produces an adverse interaction. However, individuals should not take benzodiazepines and kava together unless supervised by a doctor.
In a study of healthy volunteers, administration of St. John's wort (Hypericum perforatum) along with alprazolam decreased blood levels of alprazolam, compared with the levels when alprazolam was taken by itself.3 Individuals taking alprazolam should not take St. John's wort without supervision by a doctor.
This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.
In various studies of children treated with valproic acid for epilepsy compared with control groups, serum zinc levels remained normal or decreased, serum copper levels remained normal or decreased, and red blood cell zinc levels were decreased. The importance of these changes and how frequently they occur remain unclear.
- Kaji M, Ito M, Okuno T, et al. Serum copper and zinc levels in epileptic children with valproate treatment. Epilepsia 1992;33:555-7.
- Lerman-Sagie T, Statter M, Szabo G, Lerman P. Effect of valproic acid therapy on zinc metabolism in children with primary epilepsy. Clin Neuropharmacol 1987;10:80-6.
- Sozuer DT, Barutcu UB, Karakoc Y, et al. The effects of antiepileptic drugs on serum zinc and copper levels in children. J Basic Clin Physiol Pharmacol 1995;6:265-9.
In a preliminary trial, an extract of periwinkle called vinpocetine was shown to produce minor improvements in short-term memory among people taking flunitrazepam, a benzodiazepine. Further study is needed to determine if vinpocetine would be a helpful adjunct to use of benzodiazepines.
- Bhatti JZ, Hindmarch I. Vinpocetine effects on cognitive impairments produced by flunitrazepam. Int Clin Psychopharmacol 1987;2:325-31.