Xanax and Suboxone may need to be taken together in certain circumstances.
There is a boxed warning about medication interactions with Suboxone, and Xanax is one of the medications that should not be taken at the same time without medical supervision. 
Suboxone contains a partial opioid agonist medication, buprenorphine. Opioid medications slow down functions of the central nervous system, causing breathing to slow, sedation, and lower blood pressure, heart rate, and body temperature.
Xanax is a benzodiazepine medication. Benzodiazepines, or benzos, are also central nervous system depressants that slow down these life-sustaining functions, often to induce relaxation and calm anxiety.
Since both of these medications act on the brain and body in similar ways (slowing down breathing, heart rate, and blood pressure, and causing drowsiness and sedation), the effects are multiplied if you take them together. This can result in serious and even life-threatening consequences.
Dangers & Risks of Mixing Xanax & Suboxone
Mixing opioids like Suboxone with benzodiazepines such as Xanax can increase the risk for a fatal overdose. In 2020, approximately 16% of opioid overdose deaths involved benzodiazepines.
Both of these medications suppress breathing and cause sedation (the main causes of fatal overdose). Both impair your ability to think clearly and make rational decisions.
When mixed, these two drugs can interact to cause the following:
- Severe drowsiness
- Breathing problems
- Decreased awareness
Both benzodiazepines and opioid medications are also habit-forming, leading to drug tolerance, dependence, and serious withdrawal symptoms. Xanax (alprazolam) is prescribed for the short-term relief of anxiety and panic disorders. Withdrawal from benzos can be potentially life-threatening if the medication is stopped suddenly after physical dependence has formed.
If you are already taking Suboxone or Xanax and may need to take them together, you should talk to your doctor so you can understand the risks and benefits and make a decision about whether or not to take these medications together.
Alternatives to Xanax
Suboxone is a Medication for Addiction Treatment (MAT) for the management of opioid use disorder (OUD). It can help to reduce cravings for opioid drugs, minimize the odds of relapse, and help to manage opioid withdrawal symptoms.
One of the symptoms of opioid withdrawal can be anxiety, and anxiety disorders commonly co-occur with opioid addiction. Xanax is commonly prescribed to help manage anxiety, but if you are taking Suboxone, this may not be a safe option for you.
There are alternatives to benzodiazepines that do not cause the same level of sedation and breathing suppression, such as antidepressants. There are also other anxiolytic medications that may be less risky, such as hydroxyzine, or Buspar. In addition to medications for the treatment of anxiety, behavioral therapies and counseling can help treat anxiety. Holistic measures, such as exercise, massage therapy, mindfulness meditation, and yoga, can all help to manage anxiety safely while taking Suboxone.
Talk to your doctor about your options. If you are using Suboxone as part of a comprehensive MAT program, your treatment team will be able to help you manage anxiety and other issues in a safe way while taking Suboxone.
- Suboxone. Indivior, PLC. https://www.suboxone.com/. 2022. Accessed September 2022.
- Benzodiazepines and Opioids. National Institute on Drug Abuse. https://nida.nih.gov/research-topics/opioids/benzodiazepines-opioids. April 2022. Accessed September 2022.
- Xanax. Viatrus, Inc. https://www.xanax.com/. 2022. Accessed September 2022.
Medically Reviewed By: Elena Hill, MD, MPH
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