Grapefruit Juice —Possible Harmful Interaction Hops, Kava, Passionflower, Valerian —Possible Harmful Interaction Melatonin —Supplementation Possibly Helpful Pregnenolone —May Decrease Activity of Drug Kava —Possibly Helpful

Medications in the benzodiazepine family exert calming and sedative effects and are used to treat anxiety and insomnia . Benzodiazepines are also used as muscle relaxants and anticonvulsants. They work by increasing the effects of the neurotransmitter (a chemical messenger) GABA. Benzodiazepine drugs include:

  • Alprazolam (Xanax)
  • Chlordiazepoxide hydrochloride (Libritabs, Librium, Limbitrol, Lipoxide, Mitran, Reposans-10, Sereen)
  • Clonazepam (Klonopin)
  • Clorazepate dipotassium (Gen-XENE, Tranxene-T, Tranxene-SD)
  • Diazepam (Diastat, Valium, Valrelease, Vazepam)
  • Estazolam (ProSom)
  • Flurazepam hydrochloride (Dalmane, Durapam)
  • Halazepam (Paxipam)
  • Lorazepam (Ativan)
  • Oxazepam (Serax)
  • Quazepam (Doral)
  • Temazepam (Razepam, Restoril, Temaz)
  • Triazolam (Halcion)
  • and others

Grapefruit juice slows the body's normal breakdown of several drugs, including some benzodiazepines, allowing them to build up to potentially dangerous levels in the blood. 1 A recent study indicates that this effect can last for 3 days or more following the last glass of juice. 2Because of this risk, if you take benzodiazepines, the safest approach is to avoid grapefruit juice altogether.

HopsKavaPassionflowerValerian The herb kava ( Piper methysticum ) has a sedative effect and is used for anxiety and insomnia. Combining kava with drugs in the benzodiazepine family, which possess similar effects, could result in "add-on" or excessive physical depression, sedation, and impairment. In one case report of a 54-year-old man hospitalized for lethargy and disorientation, these side effects were attributed to his having taken the combination of kava and alprazolam for 3 days. 3 Experimental studies suggest that kava, similarly to benzodiazepines, exerts its sedative effects at binding sites in the brain called GABA receptors. 4,5,6 Other herbs with a sedative effect that might cause problems when combined with benzodiazepines include ashwagandha ( Withania somnifera ) , calendula ( Calendula officinalis ) , catnip ( Nepeta cataria ) , hops ( Humulus lupulus ) , lady's slipper ( Cypripedium ), lemon balm ( Melissa officinalis ), passionflower ( Passiflora incarnata ), sassafras ( Sassafras officinale ), skullcap ( Scutellaria lateriflora ) , valerian ( Valeriana officinalis ), and yerba mansa ( Anemopsis californica ). Because of the potentially serious consequences, you should avoid combining these herbs with benzodiazepines or other drugs that also have sedative or depressant effects unless advised by your physician.

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