Is it safe to take Tranz (alprazolam) with elderberry?

Safety of Taking Alprazolam (Tranz) with Elderberry

Caution is advised when taking alprazolam (Tranz) with elderberry supplements due to potential interactions affecting drug metabolism. 1, 2

Potential Interactions

• Alprazolam is primarily metabolized through the hepatic cytochrome P450 3A4 (CYP3A4) enzyme pathway, making it susceptible to interactions with substances that affect this pathway 2
• Elderberry extracts have shown weak inhibition of CYP3A4 in small in vitro studies, which could potentially affect alprazolam metabolism 3
• Guidelines recommend caution when using alprazolam with substances that may affect its metabolism, as this could lead to increased drug levels and enhanced side effects 1

Specific Concerns

• Increased alprazolam levels could lead to enhanced central nervous system depression, including:

  • Excessive sedation
  • Drowsiness
  • Dizziness
  • Impaired coordination
  • Respiratory depression in severe cases 1

• A recent case report documented an interaction between elderberry and pazopanib (another medication metabolized by CYP3A4), resulting in grade 3 liver injury with symptoms resolving after discontinuation of both medications 3

Risk Assessment

• Elderberry supplements have gained popularity for their purported immune-boosting properties, particularly during respiratory illness seasons 4, 5
• While elderberry has shown some benefits for viral respiratory illnesses, the evidence regarding its safety when combined with medications like alprazolam is limited 6
• The American Family Physician guidelines specifically mention that certain medications (like nefazodone and fluvoxamine) that affect CYP450 enzymes require dose adjustments when used with alprazolam 1

Recommendations

• Consult with a healthcare provider before combining alprazolam with elderberry supplements 1

• If both must be used:

  • Monitor for signs of increased alprazolam effects (excessive sedation, coordination problems)
  • Consider a lower alprazolam dose if elderberry supplementation is necessary 1
  • Be particularly cautious if you have liver disease or are taking other medications that affect CYP3A4 2

• Discontinue elderberry if experiencing unexpected side effects while taking alprazolam 3

Special Considerations

• The American Geriatrics Society Beers Criteria highlights the risks of combining benzodiazepines like alprazolam with other substances that may increase central nervous system depression 1
• Elderly patients should be particularly cautious with this combination due to increased sensitivity to benzodiazepine effects and reduced drug clearance 2