Can a patient taking Cymbalta (duloxetine) and Wellbutrin (bupropion) take Xanax (alprazolam) 0.5mg for 5 doses over a week for travel anxiety?

From the Guidelines

I strongly advise against a patient taking Cymbalta (duloxetine) and Wellbutrin (bupropion) to take Xanax (alprazolam) 0.5mg for 5 doses over the course of a week for travel anxiety without consulting their healthcare provider first. The combination of these medications can increase the risk of sedation and CNS depression, potentially causing excessive drowsiness, dizziness, confusion, or impaired coordination 1. While the study by the American family physician does not directly address the interaction between Cymbalta, Wellbutrin, and Xanax, it does provide guidance on the use of antidepressant agents and the potential need to reduce the dose of coadministered alprazolam (Xanax) or triazolam by 50% when used with certain medications.

Some key points to consider when evaluating the safety of this combination include:

• The potential for increased sedation and CNS depression when combining Cymbalta and Xanax
• The need to monitor for hepatotoxicity when using certain medications with Xanax
• The importance of personalized medical evaluation due to potential drug interactions
• The need for caution when driving or operating machinery and avoiding alcohol while taking this combination of medications

Given the potential risks and interactions, it is crucial for the patient to consult their prescribing physician or psychiatrist before taking Xanax with their current regimen. The healthcare provider can assess the patient's individual situation and provide guidance on the safe use of Xanax for travel anxiety. If approved by their doctor, the patient should be cautious and follow their healthcare provider's instructions carefully.

From the FDA Drug Label

WARNINGS Dependence and Withdrawal Reactions, Including Seizures Certain adverse clinical events, some life-threatening, are a direct consequence of physical dependence to alprazolam tablets.

In contrast, patients treated with doses of alprazolam tablets greater than 4 mg/day had more difficulty tapering to zero dose than those treated with less than 4 mg/day

The patient is taking 0.5mg of Xanax for 5 doses over a week, which is a relatively low dose and short duration.

• The risk of dependence and withdrawal reactions is lower with this dosage and duration.
• However, it is still important to monitor the patient for any signs of dependence or withdrawal reactions.
• The patient should be advised to take the medication as directed and not to exceed the recommended dose or duration.
• It is also important to note that the patient is taking Cymbalta (duloxetine) and Wellbutrin (bupropion), and the potential interactions between these medications and Xanax should be considered.
• The FDA label does not provide specific guidance on the use of Xanax in patients taking Cymbalta and Wellbutrin, so caution should be exercised when prescribing Xanax to this patient 2.

From the Research

Patient Medication Interaction

• The patient is currently taking Cymbalta (duloxetine) and Wellbutrin (bupropion) and is considering taking Xanax (alprazolam) 0.5mg for 5 doses over a week for travel anxiety.
• According to 3, alprazolam is effective for treating anxiety and panic disorder, but it can cause sedation, withdrawal symptoms, and abuse.
• The study 4 suggests that combining antidepressants with benzodiazepines may be clinically useful, as it can reduce the likelihood of dropout and improve response rates in patients with major depression.

Safety and Efficacy

• However, the same study 4 notes that the potential benefits of adding a benzodiazepine to an antidepressant must be balanced against possible harm, including development of dependence and accident proneness.
• Another study 5 found that alprazolam use and dependence can lead to severe withdrawal reactions and adverse consequences, even at recommended doses.
• Additionally, 6 reports that alprazolam can be associated with potentially serious adverse events, including depression and suicide attempts, although the causal relationship is unclear.

Considerations for Short-Term Use

• Given the patient's short-term use of Xanax for travel anxiety, the risks of dependence and withdrawal may be lower compared to long-term use.
• However, it is still important to monitor the patient's response to the medication and adjust the treatment plan as needed.
• The patient's healthcare provider should also consider alternative treatments for anxiety, such as cognitive-behavioral therapy, as suggested by 3.