CBD With Xanax Interaction
In our latest question and answer, the pharmacist discusses the drug interaction between Xanax (alprazolam) and CBD (cannabidiol).
I started taking CBD hemp oil for insomnia. If it doesn’t make me sleep all night, can I take a 0.25 Xanax? I have been taking Xanax for sleep and I am trying to stop. I just want to do CBD.
At a glance
- CBD can potentially increase the effects of Xanax (alprazolam).
There is a potential interaction between CBD (cannabidiol) and Xanax (alprazolam).
There are actually two issues here:
- CBD can decrease the metabolism of Xanax, increasing its effects.
- Taking both together could cause additive sedation.
It is important to note that we don’t have a lot of data or historical information regarding CBD drug interactions, so we don’t know exactly how significant these potential effects can be. Nevertheless, I discuss both in greater detail below.
There are several ways to characterize a drug interaction and they occur via more than one mechanism.
Regarding CBD and Xanax, we not only have a ‘pharmacokinetic’ interaction in that the metabolism of Xanax may be reduced, but we also have the risk of additive side effects.
Xanax is metabolized in our body via the liver metabolizing enzyme CYP3A4. 
There is some evidence (although it isn’t strong), that CYP3A4 may be partially inhibited by CBD.   Therefore, Xanax won’t be metabolized as efficiently, leading to increased concentrations of the drug for longer periods of time. This obviously has the potential to potentiate the effects of Xanax.
I mention that the evidence isn’t strong regarding CYP3A4 inhibition because while lab studies do confirm that the enzyme is at least partially inhibited by CBD, many drug interaction studies note they haven’t seen any clinically significant effects from it. 
It would be prudent to monitor yourself for side effects with Xanax (like sedation, drowsiness and shallow breathing) if you do take it with CBD.
Both Xanax and CBD can cause sedation.
Xanax is a well-known CNS depressant and some sources classify CBD as one as well.
While CBD may certainly cause CNS depression in some form, it is not known to cause respiratory depression like Xanax (and all benzodiazepines for that matter), even at high doses.  
Nevertheless, the prescribing information for Epidiolex, a prescription CBD product, does warn about its use with other CNS depressants.
“Concomitant use of EPIDIOLEX [CBD] with other CNS depressants may increase the risk of sedation and somnolence.” Epidiolex Prescribing Information
As mentioned at the outset, there certainly is some interaction between CBD and Xanax, but how significant it is isn’t well known.
There does certainly appear to be at least some risk of additive effects, like sedation, but beyond that, they may be safe together.
Perhaps the biggest concern is the risk of respiratory depression. If CBD increases Xanax concentrations, this risk could be increased, but again, whether or not CBD inhibits CYP3A4 to a significant degree isn’t known.
Be sure to discuss the use of CBD with your doctor before using see you can be appropriately monitored for side effects and effectiveness.In our latest question and answer, the pharmacist discusses the drug interaction between Xanax (alprazolam) and CBD (cannabidiol).
What Happens When Xanax and Cannabis Mix?
The effects of mixing Xanax and cannabis aren’t well-documented, but in low doses, this combo usually isn’t harmful.
That said, everyone reacts differently, and the effects of substances become increasingly unpredictable when you mix them.
If you’ve already mixed the two, don’t panic. Unless you’ve taken a lot of Xanax, it’s not usually a life threatening combo. It can, however, cause some unpleasant side effects.
Healthline does not endorse the misuse of prescription medication. However, we believe in providing accessible and accurate information to reduce the harm that can occur from misuse.
There hasn’t been a lot of research on Xanax and weed together, so not much is known about how they interact.
We do know, however, that both are central nervous system depressants, which means they slow the messages between your brain and body.
When used individually in low doses, Xanax and weed can lower anxiety and make you feel relaxed and euphoric. In higher doses, they can worsen anxiety and cause paranoia, sedation, rapid heart rate, and irritability.
Keep in mind that what’s considered a low dose for one person might be a high dose for another, depending on their tolerance.
Combining the two may reduce the effects of each drug and make it easier to overdose on Xanax.
Possible side effects of mixing the two include:
- trouble concentrating
- slurred speech
- slowed motor coordination
- impaired judgement
If you’re going to mix Xanax and cannabis, you’ll want to avoid alcohol altogether.
Booze and benzodiazepines, like Xanax, enhance each other’s effects, including the less-than-desirable ones such as severe drowsiness and sedation. There’s also a higher risk of serious effects, mainly respiratory depression.
Experts still don’t know exactly how it happens, though one animal study showed that ethanol, the main ingredient in alcoholic drinks, appears to increase the maximum concentration of alprazolam (Xanax) in the bloodstream.
Various studies have also shown that alcohol can intensify the effects of cannabis and increase your chances of greening out or overdoing it.
Xanax is known to interact with several other drugs, including some over-the-counter (OTC) meds.
These include certain:
When you take Xanax with these drugs, they interfere with the elimination of Xanax from your body. This may cause a toxic buildup of Xanax in your system.
Avoid using Xanax with any other sedatives.
If you’re using cannabis and Xanax to manage anxiety symptoms, keep in mind that this combo can sometimes backfire.
While there’s evidence that cannabis may decrease anxiety in low doses in some people, high-THC strains can actually increase anxiety.
If you’re dealing with anxiety, your best bet is to reach out to a healthcare provider who can recommend proven anxiety treatments.
It’s best to avoid mixing Xanax with any substance that can cause drowsiness, including cannabis.
Your chances of using too much of both are higher when you mix, which could lead to a bad reaction or Xanax overdose.
If you’re going to mix them or already have, there are some things you can do to make things a bit safer:
- Stick to the lowest dose of each. Your risk of serious effects increases significantly with higher doses. Keep your Xanax dose low and stick to low-THC weed strains to reduce your risk of side effects or overdose.
- Don’t lie down. Benzos, especially when mixed with other depressants, have a severe sedating effect and can also cause nausea and vomiting. Try to remain seated when taking this combo to lower your risk of choking if you do happen to throw up.
- Choose a safe setting. This combo can make it hard for you to move around or stay awake, potentially leaving you vulnerable.
- Don’t do it alone. Have someone with you in case negative effects occur. It should be someone you trust who knows how to spot the signs of trouble and get you help if needed.
- Stay hydrated. Drinking plenty of water before, during, and after can help prevent dry mouth and dehydration. It can also help prevent some symptoms of a cannabis hangover.
- Don’t do it often. Xanax and cannabis both have dependency and addiction potential, especially when used often. Both can also cause withdrawal. Limit your use of both to reduce your risk.
- Don’t throw any other substances into the mix. The more substances you combine, the more unpredictable the effects. Most fatal overdoses result from mixing drugs with other substances, including alcohol.
Call 911 right away if you or someone else experiences any of these symptoms after mixing Xanax and weed:
- blurred vision
- slurred speech
- irregular heart rate
- shortness of breath
- slowed breathing
- loss of consciousness
If you’re caring for someone else, have them lay on their side while you wait for help to arrive. This position will help keep their airway open in case they vomit.
Xanax shouldn’t be mixed with other substances, especially other central nervous system depressants, because of the risk of blacking out and dangerously slowed breathing.
In small doses, Xanax and cannabis don’t make for a life threatening combo, but things can quickly take a turn.
Both also have a high risk of misuse and could lead to dependence or addiction.
If you’re worried about your substance use, here are some options for getting confidential help:
- Talk to your primary healthcare provider. Be honest about your drug use. Patient confidentiality laws prevent them from reporting this information to law enforcement.
- Call SAMHSA’s national helpline at 800-662-HELP (4357), or use their online treatment locater.
- Find a support group through the Support Group Project.