Alcohol, Opioids, and More: 9 Diazepam Interactions to Be Aware of

Diazepam (Valium, Diazepam Intensol) is a benzodiazepine medication. It’s used to treat conditions like anxiety, seizures, and muscle spasms. It can also be used to treat alcohol withdrawal.

Like all benzodiazepines, diazepam is a controlled substance. This means it has the potential to cause physical dependence and misuse. There are also restrictions on prescribing and refilling diazepam.

If you’ve been prescribed this medication, it’s good to be aware of its possible side effects and drug interactions. Here, we’ll cover nine important diazepam interactions to watch for.

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1. Opioids, such as hydrocodone

Benzodiazepines and opioids are both medications that slow down the brain. They can cause drowsiness and dizziness. More seriously, these medications can cause an overdose and slowed breathing if you take too much.

Compared to taking benzodiazepines or opioids alone, the risks are much higher when these medications are combined. So it’s usually best to avoid taking diazepam and opioids together. In fact, diazepam carries a boxed warning about this potential interaction.

Examples of opioids you should avoid combining with Valium include:

• Hydrocodone (Hysingla ER)

• Oxycodone (Roxicodone, OxyContin)

• Oxycodone / acetaminophen (Percocet)

• Tramadol (ConZip, Qdolo)

If you need something for pain relief, talk to your prescriber. They may recommend trying over-the-counter (OTC) pain relievers first. Examples of OTC pain relievers are ibuprofen (Advil, Motrin) and acetaminophen (Tylenol).

Good to know: If you or a loved one takes an opioid, it’s a good idea to carry naloxone (Narcan, Zimhi) with you at all times. Naloxone, which is available OTC, can quickly reverse an opioid overdose.

Can you take benzodiazepines with opioid use disorder medications?

Medication for opioid use disorder (MOUD) is the gold standard approach to treating OUD. The two most commonly used medications are methadone (Methadose) and buprenorphine-containing medications. One example is Suboxone (buprenorphine / naloxone).

Methadone itself is a “full opioid.” This means it's similar to the other opioids mentioned above. Buprenorphine is a partial opioid. So it isn’t as strong as full opioids and is less likely to cause slowed breathing or overdose. Combining methadone or buprenorphine with benzodiazepines can cause slowed breathing or overdose. So it’s best to avoid the combination.

However, if your prescriber believes benzodiazepines are necessary, experts don't recommend stopping MOUD. This is because using medications to treat OUD is typically the best approach.

EXPERT PICKS: WHAT TO READ NEXT

• What are benzodiazepines? Benzodiazepines are medications that treat several health conditions, including seizures, anxiety, and alcohol withdrawal.

• What are the most commonly used anxiety medications? Antidepressants are typically first-choice medications for anxiety. But benzodiazepines like diazepam may be a good option in some cases.

• What diazepam side effects should you watch for? Diazepam can cause drowsiness, dizziness, and more. It also has serious risks, such as misuse and overdose.

2. Alcohol

Alcohol can affect the brain in a similar way to diazepam. When combined, diazepam and alcohol can lead to serious side effects. This includes intense confusion, difficulty breathing, and suicidal thoughts or actions. For these reasons, it's best to avoid the combination of Valium and alcohol.

You may be wondering if having just one drink is safe while taking diazepam. The answer is no; there’s no amount of alcohol that’s safe to drink while taking benzodiazepines. If you drink regularly, be honest with your prescriber before starting treatment with diazepam. They may recommend a different medication. They can also help you safely reduce the amount of alcohol you drink.

3. Antipsychotics, such as Seroquel

Diazepam may interact with antipsychotic medications. Antipsychotics are used to treat conditions like schizophrenia, bipolar disorder, and depression. Like diazepam, antipsychotics also slow down the brain.

Examples of antipsychotics include quetiapine (Seroquel), aripiprazole (Abilify), and clozapine (Clozaril). Combining diazepam with these medications can increase your risk of drowsiness and low blood pressure. This can lead to falls and injuries.

If your prescriber thinks it’s necessary for you to take benzodiazepine and an antipsychotic, make sure to talk to them about the risks.

4. Sleep aids, such as diphenhydramine

Medications used to help you sleep can interact with diazepam. This can lead to excessive sleepiness and slowed breathing. Examples of these sleep aids include:

• Some OTC antihistamines, like diphenhydramine (ZzzQuil) and doxylamine (Unisom SleepTabs)

• Trazodone (an antidepressant that’s used off-label for sleep)

• Zolpidem (Ambien)

• Zaleplon (Sonata)

• Eszopiclone (Lunesta)

• Melatonin

If you’re having trouble sleeping, reach out to your healthcare team. They can help you figure out the cause of your sleep issues. It may be possible to improve your sleep with at-home remedies. Creating healthy sleep habits is a good place to start. Cognitive behavioral therapy (CBT) may also be an option.

Other medications can also cause drowsiness. For example, combination OTC products for cough and cold, like NyQuil (acetaminophen / dextromethorphan / doxylamine) and Benadryl (diphenhydramine), can also cause drowsiness. So make sure your prescriber and pharmacist have a complete list of all the medications you take. This will help them weigh the risks versus benefits of medications that can potentially interact with diazepam.

5. Muscle relaxers, such as cyclobenzaprine

Similar to diazepam, muscle relaxers can cause drowsiness and dizziness. Examples include carisoprodol (Soma), cyclobenzaprine (Amrix), and baclofen. These medications typically should be avoided with diazepam. In addition to drowsiness and dizziness, this combination can lead to slowed breathing and overdose.

Talk to your prescriber if you take a muscle relaxer. They’ll likely recommend changes to your medication regimen that help you avoid using diazepam and a muscle relaxer together.

6. Seizure medications, such as gabapentin

Seizure medications, like diazepam, prevent and treat seizures. They affect the brain and can cause drowsiness and dizziness. These side effects may be amplified if you take multiple seizure medications together.

Seizure medications that may interact with diazepam include gabapentin (Neurontin), lamotrigine (Lamictal), and carbamazepine (Tegretol). Like diazepam, these medications can also cause drowsiness and dizziness.

Diazepam may also interact with seizure medications in other ways. For example, carbamazepine can decrease blood levels of diazepam, making it less effective.

Despite these risks, diazepam may be prescribed with other seizure medications. The benefits of this combination may outweigh the risks if it helps manage your seizures. Your prescriber can help you decide.

7. Some antidepressants, such as Lexapro

Like diazepam, some antidepressants can cause drowsiness and dizziness. They may also cause insomnia, which can cause daytime drowsiness as a result. Examples of antidepressants that can affect sleep include:

• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and escitalopram (Lexapro)

• Trazodone

• Mirtazapine (Remeron)

Besides causing drowsiness, some antidepressants can affect diazepam levels in the body. For example, fluoxetine and fluvoxamine (Luvox) can block the breakdown of diazepam in the body because of how it affects certain liver enzymes (proteins). This can increase blood levels of diazepam and worsen side effects.

If you need to take both diazepam and an antidepressant, your prescriber will help you choose a safe combination. But if you feel excessively drowsy or dizzy while taking the medications, talk to your healthcare team about what to do next.

8. Some antifungals, such as Diflucan

As mentioned, certain medications can block the breakdown of diazepam in the body. This can lead to increased blood levels of diazepam, which raises the risk of side effects. Some antifungals, like ketoconazole and fluconazole (Diflucan), can interact with diazepam in this way. Making sure your prescriber and pharmacist know about all the medications you take can help avoid this type of interaction.

9. Stimulants, such as Adderall

Stimulants are medications that treat conditions like attention deficit-hyperactivity disorder (ADHD) and narcolepsy. Like diazepam, stimulants are also categorized as controlled substances. Examples include:

• Amphetamine salt combo (Adderall, Adderall XR)

• Methylphenidate (Ritalin, Concerta, others)

• Lisdexamfetamine (Vyvanse)

Stimulants and diazepam can both cause dependence and misuse. There may be a higher risk of misuse when these medications are combined. What’s more, stimulants can counteract the effects of diazepam. For example, while diazepam calms your nerves, stimulants can make you feel more jittery.

Discuss the potential risks of combining diazepam and stimulants with your prescriber. They may recommend avoiding the combination entirely.

Can you take diazepam with ibuprofen or Tylenol?

Yes, diazepam can typically be taken with OTC pain relievers like ibuprofen or Tylenol. There’s no direct interaction between diazepam and these medications.

However, it’s always a good idea to check with your prescriber before taking an OTC pain reliever. Some people should avoid ibuprofen or Tylenol. For example, if you have existing heart problems, acetaminophen may be preferred over ibuprofen.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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