Quick Answer: In most cases, no. Xanax (alprazolam, a benzodiazepine) and Suboxone (buprenorphine/naloxone, an opioid medication) both slow the brain and breathing. Combining them raises the risk of extreme sleepiness, slowed or stopped breathing, overdose, coma, and death. Prescribers sometimes decide to prescribe both with close monitoring, but never mix them on your own, and never stop either one suddenly without medical guidance.
Medical emergency: If someone is extremely drowsy, can’t be woken, is breathing slowly or not at all, or has blue or gray lips, call 911 and give naloxone (Narcan) if available. If you have thoughts of suicide, call or text 988.
When it comes to prescription medications, interactions between certain pharmaceuticals can be harmful. It is vital to be honest with your doctor about any medications you are taking so you can avoid adverse interactions.
Two medications you should avoid taking at the same time are Xanax (alprazolam) and Suboxone (buprenorphine/naloxone). Xanax is a benzodiazepine anxiety medication and Suboxone is used to treat opioid use disorder, and since addiction and mental health issues often co-exist, there is a possibility of these medications being prescribed at the same time. On the other hand, some drug users who are taking Suboxone may try mixing it with benzodiazepines to get high.
Mixing Suboxone and Xanax, especially in an attempt to get high, can be extremely harmful. Taking too many of these medications at once can lead to respiratory depression, overdose, and death.
What is Xanax (Alprazolam)?
Xanax is the most widely prescribed benzodiazepine medication. It is used to treat anxiety and panic disorders as well as insomnia.
Xanax works by enhancing the activity of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter that acts as an inhibitory messenger in the brain. Its primary role is to reduce the activity of nerve cells, helping to create a calming and relaxing effect. When Xanax binds to GABA-A receptors, it enhances the effects of GABA. This increased GABA activity leads to reduced neuronal firing, reducing excessive excitement in the brain and resulting in less anxiety.
Xanax is a potent medication that must be used with caution. It can be habit-forming and abruptly stopping the use of it may result in severe withdrawal symptoms. It’s important to avoid combining Xanax with alcohol or other central nervous system depressants, as this can increase the risk of dangerous side effects.
Common side effects of Xanax are:
- Drowsiness
- Dizziness
- Fatigue
- Impaired coordination
- Memory problems
- Slurred speech
- Headache
- Nausea
- Constipation
- Dry mouth
- Changes in appetite
- Changes in sex drive
- Irritability
- Blurred vision
- Muscle weakness
- Loss of balance or coordination
- Difficulty concentrating
What is Suboxone (Buprenorphine/Naloxone)?
Suboxone is a medication that contains two drugs: buprenorphine and naloxone.
Buprenorphine, an opioid partial agonist, activates the same opioid receptors in the brain that opioids like heroin or prescription painkillers target. However, buprenorphine has a ceiling effect, meaning that after a certain point, increasing the dosage doesn’t lead to stronger opioid effects, reducing the risk of overdose. Buprenorphine provides relief from withdrawal symptoms and cravings without producing the intense euphoria associated with full opioid agonists.
Naloxone is an opioid receptor agonist that is added to Suboxone to prevent misuse. It has minimal effects when taken as prescribed, but if it is crushed or injected, naloxone becomes active and quickly blocks the effects of other opioids in the system. This can result in sudden withdrawal symptoms which are thought to deter misuse.
Suboxone is used to treat opioid dependence and addiction. It may be prescribed to treat symptoms of withdrawal during detox and to reduce cravings and the risk of relapse in early recovery.
Common side effects of Suboxone are:
- Drowsiness
- Dizziness
- Fatigue
- Impaired coordination
- Memory issues
- Slurred speech
- Headache
- Nausea
- Constipation
- Dry mouth
- Excessive saliva production
- Changes in appetite
- Weight fluctuations
- Altered sex drive
- Insomnia
- Irritability
- Blurred vision
- Muscle weakness
- Balance or coordination problems
Suboxone is a central nervous system depressant and it should not be combined with other depressant drugs, including Xanax.
Xanax vs. Suboxone: Key Differences and Shared Risks
| Xanax (alprazolam) | Suboxone (buprenorphine/naloxone) | |
|---|---|---|
| Drug class | Benzodiazepine | Opioid partial agonist + opioid blocker (naloxone) |
| Used for | Anxiety and panic disorder | Opioid use disorder |
| Controlled substance schedule | Schedule IV | Schedule III |
| Effect on breathing | Can slow breathing, especially with other sedatives | Limited by a ceiling effect alone, but can slow breathing when combined with sedatives |
| If stopped suddenly | Seizures and severe withdrawal are possible | Opioid withdrawal, cravings, and higher relapse and overdose risk |
Effects both can cause: drowsiness, dizziness, impaired coordination, slowed thinking, blurred vision, and slurred speech. Taking them together can intensify every one of these effects.
The Dangers of Mixing Xanax and Suboxone
Unless you are directed to do so by your doctor, you should never mix opioids like Suboxone with benzodiazepines like Xanax. Mixing opioids and benzodiazepines can increase the risk of overdose, and up to 90% of all benzodiazepine overdose deaths also involve opioids.
Suboxone and Xanax share many of the same side effects, and both suppress breathing, cause sedation, and impair your ability to think clearly. When taken together, these side effects can become enhanced, resulting in:
- Slowed brain activity
- Severe drowsiness
- Extreme dizziness
- Breathing problems
- Reduced respiratory functioning
- Sedation
- Overdose
- Coma
- Death
Respiratory depression is the most worrisome consequence of combining Xanax and Suboxone. This condition involves slow and shallow breathing, which can eventually lead to oxygen deprivation, unconsciousness, or even death. The interaction between benzodiazepines like Xanax and opioids like buprenorphine in Suboxone can significantly amplify this risk. Unfortunately, when the body’s ability to regulate breathing becomes compromised, the likelihood of a life-threatening situation increases.
Doesn’t Suboxone’s “Ceiling Effect” Make This Safe?
Buprenorphine’s ceiling effect means that, taken alone, raising the dose doesn’t keep increasing its effect on breathing the way it does with full opioids. That is one reason Suboxone has a lower overdose risk than many other opioids. But the ceiling effect doesn’t protect you when other sedatives are added. Benzodiazepines like Xanax, along with alcohol and other depressants, can push breathing down to dangerous levels even at doses of buprenorphine that would otherwise be safer.
What to Do If Both Medications Are Prescribed to You
Sometimes a prescriber decides the benefits outweigh the risks, for example when someone has a serious anxiety or panic disorder, and opioid use disorder treatment shouldn’t be withheld. If that applies to you:
- Take both exactly as prescribed, never more, and never at a different time or dose than directed
- Don’t drink alcohol or take other sedatives, sleep aids, or muscle relaxants without asking
- Keep naloxone (Narcan) at home and make sure someone close to you knows how to use it
- Don’t drive or use machinery if you feel drowsy
- Don’t stop either medication suddenly. Stopping Xanax abruptly can cause seizures, and stopping Suboxone abruptly raises the risk of relapse and overdose. Ask your prescriber about a plan.
Questions to ask your prescriber:
- Is it safe for me to take both, and for how long?
- Are there non-benzodiazepine options for my anxiety?
- What symptoms mean I should call you or go to the ER?
- Should I have naloxone at home?
- How can we safely taper off Xanax if we decide to?
Signs of an Overdose and What to Do
Signs: Extreme drowsiness or inability to wake, very slow or shallow breathing, gurgling or choking sounds, blue or gray lips or fingertips, confusion, limp body.
What to do:
- Call 911 immediately.
- Give naloxone (Narcan) if you have it. It may take more than one dose when buprenorphine or benzodiazepines are involved, and it doesn’t reverse the effects of benzodiazepines, so keep calling for emergency help either way.
- Keep the person awake and breathing. If they’re unresponsive, lay them on their side.
- Stay until help arrives.
If someone took both and seems fine, don’t leave them alone. Call Poison Control at 1-800-222-1222 or their prescriber for guidance.
Managing Anxiety Safely While Taking Suboxone
Benzodiazepines are generally avoided in people with a history of substance use disorder because of the risk of misuse and dependence. Safer options your prescriber may discuss include:
| Approach | Examples |
|---|---|
| Therapy | Cognitive behavioral therapy (CBT), trauma-informed therapy, dual-diagnosis treatment |
| Non-habit-forming medication | SSRIs or SNRIs, buspirone (your prescriber decides what fits) |
| Lifestyle and holistic support | Regular sleep, exercise, breathing and relaxation practices, yoga, art therapy |
Some other medicines also cause drowsiness and can add to the effects of buprenorphine, including certain sleep aids, gabapentin, hydroxyzine, and muscle relaxants. Ask your prescriber before adding anything new.
Which Level of Care Is Right for Anxiety and Opioid Recovery?
Many people manage anxiety during opioid recovery with outpatient care. A higher level of structure is more appropriate if you:
- Are already taking Xanax or other sedatives with Suboxone and can’t stop on your own
- Take more than prescribed, or use pills not prescribed to you
- Also use alcohol, fentanyl, or other substances
- Have had a past overdose or severe withdrawal
- Have severe anxiety, panic, depression, or thoughts of self-harm
- Don’t have a safe, supportive place to recover
At Moving Mountains Recovery in Randolph, NJ, we help clients access detox placement when medical withdrawal support is needed, and we provide Partial Care (PHP), Intensive Outpatient (IOP), and Outpatient (OP) care, plus dual-diagnosis treatment for the anxiety and trauma that often accompany substance use. Learn more about Suboxone treatment in New Jersey and treatment for anxiety and addiction. Call (973) 453-0317 or verify your insurance. For free, confidential referrals 24/7, call the SAMHSA National Helpline at 1-800-662-4357.
Find the Help You Need Today
At Moving Mountains Recovery, our top priority is ensuring you receive the comprehensive dual diagnosis care you need to maintain long-term sobriety. We understand that recovery is a case-by-case process, and what works for one person may not work for another. That’s why our programs focus on individually-tailored treatment and holistic care.
Whether you’re interested in learning about Suboxone treatment or would like to discuss your other treatment options, please contact our team today,
Frequently Asked Questions About Xanax and Suboxone
Can you take Xanax while taking Suboxone?
Generally no, unless a prescriber has deliberately prescribed both and is monitoring you. Combining a benzodiazepine like Xanax with an opioid medication like Suboxone can cause extreme sleepiness, slowed or stopped breathing, coma, and death. Never combine them on your own, and don’t stop either medication suddenly without medical guidance.
Is it ever safe to take Xanax and Suboxone together?
Sometimes prescribers decide the benefits outweigh the risks, for example when someone has a serious anxiety or panic disorder. Even then, it carries real risk, so it usually involves the lowest effective dose, the shortest time, close monitoring, naloxone on hand, and no alcohol. Follow your prescriber’s plan exactly.
What happens if you mix Xanax and Suboxone?
Both slow the brain and breathing. Together they can cause heavy sedation, confusion, slowed or shallow breathing, loss of consciousness, overdose, coma, and death. The risk is higher with higher doses, alcohol, other sedatives, or illicit fentanyl.
How long after Suboxone can I take Xanax?
There isn’t a safe waiting time. Buprenorphine stays in the body for a day or more, so spacing out doses doesn’t remove the interaction. Ask your prescriber before taking Xanax, and don’t use timing to combine them yourself.
Doesn’t Suboxone’s ceiling effect make it safe to take with Xanax?
No. The ceiling effect limits how much buprenorphine alone can slow breathing, but it doesn’t protect you when benzodiazepines or other sedatives are added. Combining buprenorphine with benzodiazepines is a recognized risk factor for overdose.
What can I take for anxiety while on Suboxone?
Options often include cognitive behavioral therapy, non-habit-forming medications such as SSRIs, SNRIs, or buspirone, and sleep and stress routines. Some other sedating medicines, including certain sleep aids, gabapentin, hydroxyzine, and muscle relaxants, can add to drowsiness, so ask your prescriber before adding any.
What should I do if I took Xanax and Suboxone together?
If the person is extremely drowsy, can’t be woken, or is breathing slowly, call 911 and give naloxone if available. If they seem fine, don’t leave them alone, and call Poison Control at 1-800-222-1222 or their prescriber. Don’t drive, and don’t take more.
Can I stop Xanax while taking Suboxone?
Not suddenly. Stopping Xanax abruptly after regular use can cause seizures and severe withdrawal, so a prescriber should plan a gradual taper. Don’t stop Suboxone suddenly either, because it raises the risk of relapse and overdose. If you’re struggling to cut back, call Moving Mountains Recovery at (973) 453-0317 or the SAMHSA National Helpline at 1-800-662-4357.
References:
-
- U.S. Food and Drug Administration (FDA): Xanax Alprazolam Tablets, Retrieved August 2023 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/018276s052lbl.pdf
- U.S. Food and Drug Administration (FDA): Suboxone, Retrieved August 2023 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022410s000lbl.pdf
