Can Combining Suboxone and Xanax be Risky?
Taking Suboxone with Xanax or other benzodiazepines raises the risk of slowed breathing. What the FDA warning says and what to tell your provider.
Medically reviewed by Daniel R. Karlin, MD, MA, Chief Medical OfficerPubMedGoogle Scholar
Yes. Suboxone and Xanax can be a dangerous combination because both can contribute to sedation and slowed breathing. If you take both, tell your prescribers and your pharmacist, and do not change either medication on your own.
Taking Subs with Xanax
The prescribing information for Suboxone carries a warning about using it with benzodiazepines such as Xanax and with other sedatives. These two drugs should not be taken together without medical supervision. Mixing Suboxone with other central nervous system depressants, such as Xanax, is especially dangerous because of the risk of life threatening consequences like respiratory depression and oxygen deprivation. FDA Suboxone prescribing information
Suboxone contains buprenorphine, a partial opioid agonist, with naloxone. Xanax contains alprazolam, which belongs to the benzodiazepine group. Both act on the central nervous system.
Combining benzodiazepines with opioid medications increases the risk of central nervous system depression and overdose.
The FDA also advises against categorically withholding buprenorphine or methadone solely because a patient takes benzodiazepines or other central nervous system depressants. The risks call for careful management. So do not hide benzodiazepine use out of fear that you will lose access to addiction treatment.
Taking both Xanax and Suboxone should only be considered under medical supervision, ideally with the involvement of a family doctor or addiction treatment specialist. Alprazolam enhances the action of GABA, an inhibitory chemical signal in the brain. Buprenorphine acts at opioid receptors. Their combined effects can impair alertness and breathing, especially with alcohol or other sedating medicines. Misuse of these two medications can lead to fatal outcomes. Only a healthcare provider should prescribe Xanax, and prescribed Xanax should be taken exactly as directed. Always tell your doctor if you take Xanax or are considering it while on Suboxone treatment.
Taking Suboxone and Xanax together to get high, or to push past the maximum effect of Suboxone, can be extremely hazardous and even fatal. Buprenorphine's ceiling effect does not remove this danger, and the naloxone inside Suboxone does not protect someone from all overdose risks. Do not take these two drugs together without a doctor's guidance.
Understanding Anxiety Medication
Managing anxiety disorders, such as generalized anxiety disorder and panic disorders, often involves a combination of therapy and medication. Anxiety medications help many people control anxiety symptoms and improve their quality of life. Among the most commonly prescribed options are selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs).
While SSRIs and SNRIs are commonly used for long-term management of anxiety disorders, some individuals may be prescribed benzodiazepines like Xanax for immediate relief of severe anxiety or panic attacks. However, benzodiazepines are central nervous system depressants and can be habit-forming, especially for those with a history of substance use disorder or opioid addiction.
When treating opioid use disorder with Suboxone, a medicine used to treat opioid dependence and withdrawal symptoms, it is essential to be cautious about mixing it with other medications, particularly other central nervous system depressants like Xanax. Taking Suboxone and Xanax together can increase the risk of central nervous system depression, suppress breathing, and potentially lead to a fatal overdose. This is why medical supervision and open communication with your treatment team are critical when developing an individualized treatment plan.
In addition to medication, behavioral therapies such as cognitive behavioral therapy (CBT) and holistic practices like yoga, meditation, and art therapy can help in managing anxiety symptoms. These approaches can sit alongside your treatment plan to address both mental health and substance use concerns.
If you are receiving Suboxone treatment and need to treat anxiety, always tell your doctor about all medications you are taking, including any anxiety medications. Share the dose and timing of every prescribed and nonprescribed medicine, how long you have taken it, and any alcohol or other substance use. Mention episodes of extreme sleepiness, falls, memory problems, or breathing concerns. Your healthcare provider can then help you avoid adverse interactions and build a plan that fits you.
Potential Perils of Combining Suboxone & Xanax
Combining Suboxone and Xanax is especially dangerous because both are central nervous system depressants. This drug combination can result in life threatening consequences, including severe respiratory depression, overdose, and death.
Mixing opioids with benzodiazepines can cause oxygen deprivation due to suppressed breathing, which can quickly become fatal.
The combination of Suboxone and Xanax has the potential to produce the following effects (these effects are more likely when two medications from the opioid and benzodiazepine group are combined):
- Feeling extremely sleepy
- Difficulty breathing
- Diminished consciousness
- Unconsciousness
- Death
Misuse of these medications increases the risk of overdose and death.
The use of benzodiazepines and opioid drugs can lead to habituation, which can cause:
- Tolerance
- Physical dependence, potentially resulting in hazardous withdrawal effects like seizures
- Misuse of opioids or of sedatives with anxiety-relieving properties
Regular benzodiazepine use can produce physical dependence. Abrupt discontinuation or rapid reductions can cause severe withdrawal, including seizures. The 2025 ASAM-led joint benzodiazepine tapering guideline recommends an individualized, supervised taper when tapering is appropriate. ASAM: 2025 benzodiazepine tapering guideline
Xanax (alprazolam) is prescribed for anxiety and panic disorders, often as a temporary solution. Do not stop it abruptly once you have been taking it regularly. Likewise, do not stop Suboxone on your own because you read about an interaction. Contact the treating clinician for a coordinated plan.
Suppose you have already been prescribed Suboxone for opioid use disorder or Xanax for anxiety and are considering taking them together. In that case, it is important to discuss the risks and potential benefits with your doctor in order to make an informed decision. A clinician may decide that continuing both for a time, with close coordination, is preferable to the risks of untreated opioid use disorder or abrupt benzodiazepine withdrawal. There is no universally safe number of hours to separate the two medicines.
Suboxone contains buprenorphine, an opioid partial agonist, and naloxone, an opioid antagonist. It is used to reduce cravings and withdrawal.
Addiction treatment should always be coordinated with a medical professional to avoid dangerous drug combinations.
If someone cannot be awakened, is breathing very slowly, or has stopped breathing, call 911 and give naloxone if available. Naloxone reverses opioid effects, not benzodiazepine effects, which is one reason emergency assessment is still needed after it is given. CDC: Responding to an overdose
Substitutes to Xanax for Stress and Panic Attack
Anxiety and panic disorder can be treated with alternatives to Xanax, such as cognitive-behavioral therapy. Cognitive-behavioral therapy can help a person identify and change thought patterns and behaviors that are contributing to anxiety and panic. There are also non-benzodiazepine medicines, which your prescriber can discuss with you. Anxiety management for individuals with opioid use disorder should be carefully coordinated as part of the overall addiction treatment plan.
MAT for OUD can be aided through the use of Suboxone, which is a key component of addiction treatment for opioid use disorder. This drug can decrease the temptation to return to opioids, reduce the risk of relapse, and ease the symptoms of opioid withdrawal.
Anxiety is a symptom of opioid withdrawal, and it often occurs alongside opioid addiction. Because Xanax and Suboxone together carry the risks described above, your prescribers may review why Xanax was prescribed and consider other approaches to the underlying condition. Some antidepressants used for mood disorders can also help with anxiety management. Those decisions depend on the individual. Avoid adding over-the-counter sleep aids or other sedating products without checking with a clinician or pharmacist. If you want to learn more about the signs of addiction, resources are available.
Utilizing Whole-Person Approaches to Manage Anxiety
In order to manage anxiety while taking Suboxone, behavioral therapies, counseling, and other holistic practices can be beneficial. These can be an important part of anxiety management for individuals receiving addiction treatment. Among these are:
- Working out
- Receiving a massage
- Practicing mindfulness meditation
- Doing yoga
Consult your physician regarding your choices. If Suboxone is part of your Medication-Assisted Treatment, whether you are weighing methadone or Suboxone or are already settled on a plan, your care team can help you cope with anxiety and other issues while you take it.
Start Suboxone treatment online. You can see one of our Suboxone doctors online, by video. The first visit is $89. Follow-up visits are $50 weekly, $75 every two weeks or $89 monthly. Visits are cash pay, and medication is priced separately.