Drug Interactions:
Benzodiazepines

Medications in the benzodiazepine family exert calming and sedative effects and are used to treat anxiety and insomnia. Benzodiazepines are also used as muscle relaxants and anticonvulsants. They work by increasing the effects of the neurotransmitter (a chemical messenger) GABA. Benzodiazepine drugs include

• alprazolam (Xanax)
• chlordiazepoxide hydrochloride (Libritabs, Librium, Limbitrol, Lipoxide, Mitran, Reposans-10, Sereen)
• clonazepam (Klonopin)
• clorazepate dipotassium (Gen-XENE, Tranxene-T, Tranxene-SD)
• diazepam (Diastat, Valium, Valrelease, Vazepam)
• estazolam (ProSom)
• flurazepam hydrochloride (Dalmane, Durapam)
• halazepam (Paxipam)
• lorazepam (Ativan)
• oxazepam (Serax)
• quazepam (Doral)
• temazepam (Razepam, Restoril, Temaz)
• triazolam (Halcion)
• and others

Grapefruit Juice

Possible Harmful Interaction

Grapefruit juice slows the body's normal breakdown of several drugs, including some benzodiazepines, allowing them to build up to potentially dangerous levels in the blood.¹ A recent study indicates this effect can last for 3 days or more following the last glass of juice.²

Because of this risk, if you take benzodiazepines, the safest approach is to avoid grapefruit juice altogether.

Hops, Kava, Passionflower, Valerian

Possible Harmful Interaction

The herb kava(Piper methysticum) has a sedative effect and is used for anxiety and insomnia.

Combining kava with drugs in the benzodiazepine family, which possess similar effects, could result in "add-on" or excessive physical depression, sedation, and impairment. In one case report of a 54-year-old man hospitalized for lethargy and disorientation, these side effects were attributed to his having taken the combination of kava and alprazolam for 3 days.³

Experimental studies suggest that kava, similarly to benzodiazepines, exerts its sedative effects at binding sites in the brain called GABA receptors.^4,5,6

Other herbs with a sedative effect that might cause problems when combined with benzodiazepines include ashwagandha(Withania somnifera), calendula(Calendula officinalis), catnip(Nepeta cataria), hops(Humulus lupulus), lady's slipper (Cypripedium), lemon balm(Melissa officinalis), passionflower(Passiflora incarnata), sassafras (Sassifras officinale), skullcap(Scutellaria lateriflora), valerian(Valeriana officinalis), and yerba mansa (Anemopsis californica).

Because of the potentially serious consequences, you should avoid combining these herbs with benzodiazepines or other drugs that also have sedative or depressant effects unless advised by your physician.

Melatonin

Supplementation Possibly Helpful

Melatonin is a natural hormone that regulates sleep.

Many people who take conventional sleeping pills (most of which are in the benzodiazepine family) find it difficult to quit. The reason is that when you try to stop the medication, you may experience severe insomnia or interrupted sleep. A double-blind placebo-controlled study of 34 individuals who regularly used such medications found that melatonin at a dose of 2 mg nightly (in a controlled-release formulation) could help them discontinue the use of the drugs.⁷

Warning: It can be dangerous to stop using benzodiazepines if you have taken them for a while. Consult your physician before trying melatonin to help handle benzodiazepine withdrawal or before trying to stop benzodiazepine medication under any conditions.

Kava

Possibly Helpful

Although they are highly effective for anxiety, benzodiazepine drugs can cause unpleasant and dangerous withdrawal symptoms when they are discontinued.

A 6-week double-blind placebo-controlled trial of 40 people who had been taking benzodiazepines found that use of kava significantly reduced withdrawal symptoms and helped maintain control of anxiety.⁸

Note: This trial involved close medical supervision and very gradual tapering of benzodiazepine dosages. Do not discontinue antianxiety medications except on the advice of a physician, as withdrawal symptoms can be life threatening.

Last reviewed March 2002 by Medical Review Board

Back to Top