Can You Take Alprazolam and Alcohol Together?

What Is Alprazolam?

Alprazolam, commonly known by the brand name Xanax, is a prescription medication in the benzodiazepine class. It works by enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that reduces brain activity, producing a calming and sedative effect.

Doctors most often prescribe alprazolam for:

• Generalised Anxiety Disorder (GAD)
• Panic Disorder
• Short-term relief from severe anxiety symptoms
• Insomnia

Due to its fast-acting properties, alprazolam is among the most widely prescribed psychiatric medications in the United States. However, it is also one of the most frequently misused. Tolerance and physical dependence can develop quickly, and misuse often involves taking higher doses than prescribed or mixing it with other substances—particularly alcohol—to enhance its effects.

Can Mixing Xanax and Alcohol Lead to Blackouts or Overdose?

It may be hard to believe that two readily available substances could be so harmful when used together. But yes, mixing alprazolam and alcohol is especially dangerous because both depress the central nervous system, which slows brain activity, impairs coordination, and lowers inhibitions. Instead of balancing each other, they’re combined effects are amplified, resulting in unpredictable and dangerous outcomes.

Some of the significant risks include:

• Extreme Sedation: Drowsiness, confusion, and impaired coordination that increase the risk of accidents and injuries.
• Respiratory Depression: Both alprazolam and alcohol can slow breathing, and together they can lower oxygen levels to a dangerous point.
• Memory Loss and Blackouts: Many people experienced significant gaps in memory, sometimes spanning hours or days.
• Overdose Risk: Both substances can be fatal in large doses, but when combined, they significantly raise the chance of overdose.
• Increased impulsivity: Poor decision-making can lead to risky behaviors, unsafe driving, or aggression.

Blackouts and overdoses frequently happen when alprazolam is mixed with alcohol, especially in social settings where alcohol consumption can be heavy and benzodiazepines are used recreationally. According to the Centers for Disease Control and Prevention (CDC), nearly one in five emergency room visits related to benzodiazepines involve alcohol. This combination is also one of the leading causes of polysubstance-related overdoses in the US.

In fact, the dangers of mixing Xanax with alcohol are so serious that the FDA issued a box warning label on Xanax, outlining the risks of abuse, misuse, addiction, physical dependence, and life-threatening withdrawal reactions right on the box. It emphasizes that when used with alcohol, it can lead to coma and death.

Are Women More Vulnerable to the Effects of Mixing Benzos and Alcohol?

Yes, research shows that women may experience stronger effects from mixing alprazolam and alcohol compared to men. Several factors contribute to this vulnerability, including:

• Metabolism: Women generally have lower levels of alcohol dehydrogenase, the enzyme responsible for breaking down alcohol in the body. As a result, alcohol remains in their bloodstream at higher concentrations for a longer period.
• Body Composition: Women generally have a higher body fat percentage and less total body water than men. Since alcohol distributes in water, this leads to more pronounced effects at lower doses.
• Prescription Patterns: Studies indicate women are prescribed benzodiazepines more frequently than men, especially for anxiety and insomnia. This heightens the risk of unintentional mixing with alcohol.
• Hormonal Influences: Fluctuations in hormone levels during the menstrual cycle can also impact how women metabolize alcohol and medications.
• History of Trauma: Women who experienced trauma, mental health disorders, or domestic violence often turn to polysubstance use and can’t afford to get addiction help.

Due to these biological and social factors, women may experience more intense sedation, a higher risk of blackouts, and an increased chance of overdose when combining alprazolam and alcohol, whether intentionally or accidentally. 

Women from low-income households often face some of the most complex and underrepresented challenges when seeking treatment for drug or alcohol addiction. That’s where Medicaid addiction treatment centers like Pioneer play a vital role in bridging the gap, providing affordable and accessible recovery services.