Alprazolam and Cyclosporine Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Alprazolam
Cyclosporine Injection
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased ALPRAZolam exposure and an increased risk of ALPRAZolam-related adverse reactions
Interaction Deep Dive
Avoid concomitant use of ALPRAZolam (CYP3A4 substrate) with a moderate or weak CYP3A4 inhibitor as it may increase the exposure of ALPRAZolam and increase the risk of adverse reactions. If concomitant use is necessary, consider appropriate dose reduction of ALPRAZolam. In pharmacokinetic analyses, coadministration of ALPRAZolam with moderate or weak CYP3A inhibitors resulted in increased AUC, Cmax, and t (1/2)12 and reduced clearance 1234.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of ALPRAZolam
Literature reports
4 reports — tap to read
a) In in-vivo drug interactions studies, concomitant use of ALPRAZolam with weak or moderate CYP3A4 inhibitors increased ALPRAZolam AUC as follows: fluvoxaMINE by 1.96-fold and erythromycin by 1.61-fold 12.
b) Coadministration of cimetidine (CYP3A4 inhibitor) with ALPRAZolam increased ALPRAZolam Cmax by 82% and t(1/2) by 16% and decreased clearance by 42% 12.
c) The influence of cimetidine on ALPRAZolam pharmacokinetics was evaluated in healthy subjects who ingested 1 mg ALPRAZolam with and without concurrent cimetidine 300 mg every 6 hours. The clearance of ALPRAZolam was significantly reduced from 1.66 mL/min/kg to 1.05 mL/min/kg 3. In a separate pharmacokinetic analysis, the clearance of ALPRAZolam was markedly reduced with concurrent cimetidine administration 4.
d) When fluvoxaMINE maleate (100 mg once a day) and ALPRAZolam (1 mg four times a day) were coadministered to steady state, plasma concentrations and other pharmacokinetic parameters (AUC, Cmax, t1/2) of ALPRAZolam were approximately twice those observed when ALPRAZolam was administered alone; oral clearance was reduced by about 50%. This interaction, may be more pronounced if a 300 mg daily dose is coadministered, particularly since fluvoxaMINE exhibits non-linear pharmacokinetics over the dosage range 100-300 mg 5.
Common questions
Can I take Alprazolam and Cyclosporine Injection together?
Increased ALPRAZolam exposure and an increased risk of ALPRAZolam-related adverse reactions Always confirm with your pharmacist or prescriber before making any change.
How serious is the Alprazolam and Cyclosporine Injection interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Alprazolam or Cyclosporine Injection need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (5)
- Product Information: XANAX(R) oral tablets, alprazolam oral tablets. Pharmacia & Upjohn Co (per FDA), New York, NY, 2023. DailyMed
- Product Information: Xanax(R) XR oral extended-release tablets, alprazolam oral extended-release tablets. Pharmacia & Upjohn Co (per FDA), New York, NY, 2023. DailyMed
- Abernethy DR, Greenblatt DJ, Divoll M, et al: Interaction of cimetidine with the triazolobenzodiazepines alprazolam and triazolam. Psychopharmacology 1983; 80:275-278. PubMed
- Pourbaix S, Desager JP, Hulhoven R, et al: Pharmacokinetic consequences of long term coadministration of cimetidine and triazolobenzodiazepines, alprazolam and triazolam, in healthy subjects. Int J Clin Pharmacol Ther Toxicol 1985; 23:447-451.
- Product Information: Fluvoxamine maleate oral tablets, fluvoxamine maleate oral tablets. ANI Pharmaceuticals Inc (per FDA), Baudette, MN, 2023. DailyMed
Keep reading about Alprazolam
Keep reading about Cyclosporine Injection
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
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