The Most Dangerous Combinations to Avoid
Opioids
Combining lorazepam with opioids is one of the most dangerous and potentially fatal interactions possible. Both drugs are central nervous system (CNS) depressants that slow down brain activity, heart rate, and breathing. When taken together, their sedative effects are magnified, leading to extreme sleepiness, respiratory depression (dangerously slow or shallow breathing), and a heightened risk of overdose, coma, or death. The FDA mandates a black box warning, its strongest warning, on benzodiazepine labels to highlight this severe risk.
Examples of opioids include:
- Codeine
- Hydrocodone
- Morphine
- Oxycodone
- Fentanyl
- Tramadol
Alcohol
Like opioids, alcohol is a powerful CNS depressant. Drinking alcohol while taking lorazepam can dramatically increase the sedative effects of both substances. This can result in severe drowsiness, confusion, impaired judgment, poor motor control, and suppressed breathing. The combination is also associated with an increased risk of memory impairment and loss of consciousness. Due to the body's slowed metabolism, the effects of both substances can be prolonged, further increasing the risk of accidental overdose. You should not consume alcohol for at least 24 to 48 hours after taking lorazepam.
Other Significant Drug Interactions
Other Central Nervous System (CNS) Depressants
Combining lorazepam with other medications that cause drowsiness can lead to excessively amplified sedation.
Examples include:
- Other benzodiazepines: Alprazolam, clonazepam, and diazepam.
- Muscle relaxants: Cyclobenzaprine and carisoprodol.
- Sleeping medications: Zolpidem and eszopiclone.
- Barbiturates: Phenobarbital.
Antidepressants and Antipsychotics
Certain psychiatric medications, particularly those that also cause sedation, can create risks when mixed with lorazepam. While some combinations may be prescribed under strict medical supervision, they can increase drowsiness, confusion, and coordination problems.
Examples include:
- Tricyclic antidepressants: Amitriptyline, nortriptyline.
- Antipsychotics: Quetiapine, risperidone, and olanzapine.
Anticonvulsants
Combining lorazepam with anti-seizure medications can heighten CNS depression. While sometimes prescribed together for specific conditions, doses may need to be adjusted and patients closely monitored for side effects like increased sleepiness, fatigue, and dizziness.
Examples include:
- Valproic acid (Depakene)
- Carbamazepine
- Gabapentin
Certain Antihistamines
Sedating antihistamines can significantly increase drowsiness when combined with lorazepam. Many over-the-counter (OTC) cold and allergy medicines contain these ingredients.
Examples include:
- Diphenhydramine (e.g., Benadryl)
- Doxylamine (in some sleep aids)
- Promethazine
Over-the-Counter (OTC), Herbal, and Illicit Substances
Herbal Supplements
Several herbal remedies commonly used for anxiety or insomnia can interact dangerously with lorazepam by increasing its sedative effects.
Examples include:
- Valerian root
- Kava
- Passionflower
- Melatonin
Illicit Substances
Mixing lorazepam with illicit substances is extremely hazardous and unpredictable.
Examples include:
- Cannabis: Can amplify confusion and coordination problems.
- Stimulants (e.g., cocaine): May mask the sedative effects of lorazepam but place added strain on the heart.
- Club drugs (e.g., GHB): Can cause profound sedation, memory loss, and respiratory depression.
Grapefruit and Caffeine
Certain foods and beverages can affect how lorazepam is metabolized in the body.
- Grapefruit juice: May increase the amount of lorazepam in your bloodstream, potentially leading to increased effects and toxicity.
- Caffeine: As a stimulant, caffeine can counteract the calming effects of lorazepam, especially when taken to treat insomnia.
Summary of Common Lorazepam Interactions
| Substance Type | Example(s) | Risk Level | Primary Danger |
|---|---|---|---|
| Opioids | Morphine, Oxycodone | Major (life-threatening) | Severe respiratory depression, coma, death |
| Alcohol | Beer, Wine, Spirits | Major (life-threatening) | Extreme sedation, impaired breathing, loss of consciousness |
| Other Benzodiazepines | Alprazolam (Xanax), Clonazepam (Klonopin) | Major | Excessive sedation, coordination problems, overdose |
| Muscle Relaxants | Cyclobenzaprine (Flexeril) | Major | Exaggerated sedation, slowed reaction time |
| Antidepressants | Amitriptyline, Sertraline | Moderate | Increased drowsiness, confusion, impaired coordination |
| Antihistamines (Sedating) | Diphenhydramine (Benadryl) | Moderate | Additive CNS depression, excessive sleepiness |
| Herbal Sedatives | Valerian Root, Kava | Moderate | Increased sedative effects, confusion |
| Grapefruit Juice | Grapefruit, Grapefruit Juice | Moderate | Increased lorazepam concentration, risk of toxicity |
How to Manage Medication Safely
The key to safe lorazepam use is open and honest communication with your healthcare providers. Always inform your doctor and pharmacist about all medications, supplements, and substances you are taking or plan to take. This includes prescription, OTC, herbal, and illicit substances. Your healthcare team can help manage potential interactions by adjusting dosages or recommending alternative treatments. It is also crucial to read the medication guide provided with your prescription to fully understand the risks and precautions. Remember, never stop taking lorazepam suddenly without medical advice, as this can cause severe withdrawal symptoms.
Conclusion
Understanding what you should not mix with lorazepam is essential for preventing serious, potentially fatal, adverse health events. The dangers of combining it with powerful CNS depressants like opioids and alcohol are well-documented and require the utmost caution. While interactions with other prescription drugs, OTC products, and supplements may be less severe, they still pose significant risks that should be carefully managed with professional medical guidance. Always prioritize your safety by being proactive, informing your healthcare team about everything you consume, and following their instructions precisely. For further information and resources on responsible medication use, you can visit the FDA website.
