Digoxin and Alprazolam: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Alprazolam
Digoxin
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 digoxin exposure
Interaction Deep Dive
Coadministration of ALPRAZolam and digoxin may increase digoxin exposure. When concomitant use is required, monitor serum digoxin levels prior to initiation of ALPRAZolam, continue monitoring digoxin levels and for signs of toxicity during treatment, and reduce the digoxin dose as required5612.
Why it happens (mechanism)
Unknown
Literature reports
2 reports — tap to read
a) Concomitant administration of ALPRAZolam 1.5 mg/day and digoxin resulted in no change in digoxin clearance or other pharmacokinetic variables for digoxin. In addition, creatinine clearance was not significantly affected during concomitant administration 3.
b) A 72 year-old nursing home female patient with atherosclerotic coronary vascular disease complicated by an anterior infarction and reversible congestive heart failure had a drug regimen which included oral isosorbide, furosemide, potassium chloride, and oral digoxin (0.25 mg every morning except Sunday). Serum digoxin concentrations ranged from 1.6 to 1.8 nanograms/mL (2 to 2.3 nanomol/L). The patient complained of insomnia, restlessness, and anxiety, and was started on ALPRAZolam 1 mg at bedtime. During the second week of therapy, the patient had a number of non-specific complaints and was referred to the hospital. On admission, the serum digoxin concentration was 4.3 nanograms/mL (5.5 nanomol/L). The patient's serum creatinine on admission was unchanged from previous visits. Both digoxin and ALPRAZolam were discontinued. On her third hospital day, she developed ventricular tachycardia which required lidocaine administration. Oral digoxin was restarted at 0.125 mg/day. Follow-up steady-state digoxin concentration was 1.5 nanograms/mL (1.9 nanomol/L) 4.
Common questions
Can I take Digoxin and Alprazolam together?
Increased digoxin exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Digoxin and Alprazolam 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 "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Digoxin or Alprazolam 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 (6)
- Product Information: LANOXIN(R) oral tablets, digoxin oral tablets. Concordia Pharmaceuticals Inc (per FDA), Kansas City, MO, 2019. DailyMed
- Product Information: DIGOXIN oral tablets, digoxin oral tablets. Aurobindo Pharma USA, Inc. (per Dailymed), East Windsor, NJ, May. DailyMed
- Ochs HR, Greenblatt DJ, & Verburg-Ochs B: Effect of alprazolam on digoxin kinetics and creatinine clearance. Clin Pharmacol Ther 1985; 38:595-598. PubMed
- Tollefson G, Lesar T, Grothe D, et al: Alprazolam-related digoxin toxicity. Am J Psychiatry 1984; 141:1612-1614. DOI
- Product Information: XANAX(R) oral tablets, alprazolam oral tablets. Pharmacia & Upjohn Co (per FDA), New York, NY, 2021. DailyMed
- Product Information: Xanax(R) XR oral extended-release tablets, alprazolam oral extended-release tablets. Pharmacia & Upjohn Co (per FDA), New York, NY, 2021. DailyMed
Keep reading about Alprazolam
Keep reading about Digoxin
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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