Alprazolam and Ketoconazole: Drug Interaction Guide

Quick answer: This is a major interaction — avoid combining Alprazolam and Ketoconazole unless specifically directed by your doctor.

How Alprazolam interacts with Ketoconazole

Ketoconazole is a potent CYP3A4 inhibitor and can substantially increase alprazolam concentrations, causing prolonged sedation and respiratory depression.

What you should do

Avoid co-prescribing. Use a non-CYP3A4-inhibiting antifungal or select an alternative anxiolytic.

Key facts

Severity

Major — avoid combination

Mechanism

Ketoconazole is a potent CYP3A4 inhibitor and can substantially increase alprazolam concentrations, causing prolonged se...

Action

Avoid co-prescribing. Use a non-CYP3A4-inhibiting antifungal or select an alternative anxiolytic.

Important medical disclaimer: This page provides educational information about drug interactions for general reference. It is not a substitute for professional medical advice, diagnosis, or treatment. Always discuss your specific medications with a qualified healthcare provider before starting, stopping, or changing any treatment. About our editorial team.

Frequently asked questions

Can I take Alprazolam and Ketoconazole together?

No — this combination should generally be avoided. Avoid co-prescribing. Use a non-CYP3A4-inhibiting antifungal or select an alternative anxiolytic.

What is the severity of this interaction?

The interaction between Alprazolam and Ketoconazole is classified as Major — avoid combination. Ketoconazole is a potent CYP3A4 inhibitor and can substantially increase alprazolam concentrations, causing prolonged sedation and respiratory depression.

What should I do if I'm prescribed both?

Avoid co-prescribing. Use a non-CYP3A4-inhibiting antifungal or select an alternative anxiolytic. Always consult your prescribing clinician — do not stop or change medications without medical guidance.

Last reviewed: July 11, 2026 by iMedic Medical Editorial Team. Our editorial process.