Combining the benzodiazepine Xanax and the opioid codeine can lead to a dangerous, potentially fatal overdose because they are both central nervous system depressants.
Article at a Glance:
- Xanax is the brand name for alprazolam, a benzodiazepine used for anxiety and panic disorder. Codeine is an opioid used for mild to moderate pain and cough.
- Both Xanax and codeine are controlled substances that carry a risk of dependence, abuse and addiction.
- The FDA has issued a Black Box Warning about using benzodiazepines and opioids together due to the risk of overdose and death.
Xanax and codeine are two frequently prescribed drugs. While both have potential therapeutic benefits, they also have risks and downsides that come with their use, especially when taken together.
Can You Take Xanax and Codeine Together?
You should not take Xanax and codeine together unless your doctor specifically instructs you to do so. The FDA has a Black Box Warning against mixing benzodiazepines like Xanax with opioids like codeine due to the risk of overdose and death.
What Happens When You Mix Xanax and Codeine?
When you mix Xanax and codeine, both drugs go to work, slowing down your central nervous system. Combining the drugs is dangerous because both agents depress the central nervous system. When this happens, it can cause a person to become very drowsy, sedated and have a slowed breathing rate. It can even cause a person to stop breathing and die.
Are Xanax and Codeine Prescribed Together?
Although some doctors may prescribe Xanax and codeine together for certain reasons, this practice has become rare in recent years. One factor contributing to this is that in 2016, the Centers for Disease Control and Prevention (CDC) issued guidelines recommending that doctors avoid prescribing benzodiazepines and opioids together. In addition, the FDA updated their Black Box Warnings on benzodiazepines and opioids, warning against prescribing the two substances at the same time. This has made both doctors and pharmacists more vigilant about the combination.
Drug Interactions with Xanax (Alprazolam) and Codeine
Benzodiazepines like Xanax cause many of the drug overdoses and fatalities that occur in the U.S. This is especially true when people mix Xanax with other substances, either accidentally or to heighten the effects of the substances. As a result, it can cause a dangerous or fatal overdose. About 16% of opioid overdose deaths in 2019 also involved the victim using benzodiazepines.
Xanax Drug Interactions
Some drugs can make Xanax’s effects more potent and can increase the levels of Xanax in the body. These drug interactions include combining Xanax with:
- Fluoxetine (Prozac)
- Oral contraceptives
- Carbamazepine (Tegretol)
However, Xanax can also have an additive effect with other central nervous system depressants, including opioids, muscle relaxants, sleep medications and alcohol. Mixing two or more central nervous system depressants can increase the risk of overdose.
Codeine Drug Interactions
Drugs that interact with codeine and can worsen its side effects include:
- Benzodiazepines like alprazolam (Xanax), lorazepam (Ativan), and diazepam (Valium)
- Cannabis, including cannabidiol (CBD) products
- Other opioids
- Anticholinergic drugs like amitriptyline and oxybutynin
- Kava kava
- Monoamine oxidase inhibitors (MAOIs) like selegiline (Emsam, Zelapar)
- Sleep drugs, like zolpidem (Ambien) or eszopiclone (Lunesta)
Xanax vs. Codeine
|Drug Schedule||Schedule IV controlled substance||Schedule II, III or V controlled substance, depending on the exact substanceSchedule II – codeine aloneSchedule III – codeine with acetaminophenSchedule V – codeine cough syrups|
|Risk of Dependence/Addiction||Yes (See: Xanax Addiction)||Yes (See: Codeine Addiction)|
|Overdose Risk||Yes (See: Xanax Overdose)||Yes (See: Codeine Overdose)|
|Withdrawal Symptoms||Yes (See: Xanax Withdrawal)||Yes (See: Codeine Withdrawal)|
|Length of Withdrawal||Up to 4 weeks||Up to 10 days|
|Dosages||Generalized anxiety disorder: 0.25 to 0.5 mg three times daily, up to a max of 4 mg in 24 hoursPanic disorder: 0.5 mg three times daily, up to a max of 10 mg in 24 hours||Pain: 15 to 60 mg every 4 hours as needed to a max of 360 mg in 24 hoursThe codeine dose for cough may vary based on the exact product, as codeine often comes in combination with acetaminophen, guaifenesin, promethazine, chlorpheniramine or butalbital.|
|Uses||Generalized anxiety disorder, panic disorder||Cough, mild to moderate pain|
What Is Codeine?
Codeine is a prescription medication that’s in the opioid drug class. Opioids are also known as narcotics, and they’re given to patients to relieve pain. Codeine is derived from opium, and when it goes into the brain, it converts back to morphine, where it then binds to opioid receptors. When this happens, it not only changes how the user feels pain, but it can cause a sense of euphoria or a high. This is why codeine and other opioids are considered addictive.
Unfortunately, some people view codeine as a safe opioid to take because it’s less powerful and less addictive than most other opioids, but this doesn’t necessarily make it safe. Codeine still has risks, and it’s important to be aware of what these are before taking it.
Some properties of codeine include:
|Brand names||Available as a generic drug|
|Condition||Mild to moderate|
|Short-acting or long-acting||Short-acting|
|Drug Schedule||Schedule II, III or V controlled substance, depending on the exact substanceSchedule II – codeine aloneSchedule III – codeine with acetaminophenSchedule V – codeine cough syrups|
|Side effects||Itching, constipation, nausea, vomiting, slowed breathing, sedation, drowsiness (See: Codeine Side Effects)|
|How long it takes to start working||Within 1 hour|
|How long it takes to have its peak effect||Within 1.5 hours|
|Duration of effect||4 to 6 hours|
What Is Xanax?
Xanax is the brand name of a generic drug called alprazolam that is prescribed to treat anxiety and panic disorders. Alprazolam is in a class of drugs called benzodiazepines, or benzos.
When someone takes any benzo, it acts on their central nervous system in a calming way. More specifically, Xanax and drugs like it modulate GABA, which is a naturally occurring chemical in the brain and body.
While Xanax does have a calming effect and treats symptoms of anxiety and panic, it also has side effects. Some of the side effects of Xanax can include feeling dizzy and lightheaded, as well as drowsiness. People who take Xanax are warned against drinking alcohol because it can make it difficult for them to perform normal tasks and can impact their alertness and motor skills. Other drugs can have dangerous or deadly interactions with Xanax as well, such as opioids.
Xanax is potentially habit-forming, and it’s one of the most prescribed prescription drugs in the U.S. Along with a psychological addiction, Xanax can also lead to physical dependence. If someone takes it for a period of time and then stops suddenly, they may go through Xanax withdrawal.
Some properties of Xanax include:
|Conditions it can treat||Generalized anxiety disorder, panic disorder|
|Short-acting or long-acting||Short-acting|
|Drug Schedule||Schedule IV controlled substance|
|Side effects||Drowsiness (up to 77%)|
Fatigue (up to 49%)
Coordination problems (up to 40%)
Irritability (up to 33%)
Memory problems (up to 33%)
Cognitive changes (up to 29%)
Constipation (up to 26%)
Slurred speech (up to 23%)
Decreased sex drive (up to 14%)
|How long it takes to start working||Within 1 hour|
|How long it takes to have its peak effect||Within 1 to 2 hours|
|Duration of effect||Up to 8 hours|
How long after taking Xanax can I take codeine?
A single dose of Xanax can remain in your system for about 56 hours. This is because the half-life of the drug, or how long it takes to remove half of it from your system, is around 11.2 hours. Because it takes about five half-lives to completely clear a drug from your body, a dose of Xanax can stay in your body for up to 56 hours. To be safe, you should therefore wait at least this long before taking codeine unless otherwise instructed by your doctor.
Does Xanax have codeine in it?
Xanax does not contain any codeine.
Can you take Xanax and Tylenol 3 with codeine?
You should avoid mixing Xanax and Tylenol 3 unless specifically told by your doctor to take them together. The FDA has issued a Black Box Warning about taking benzodiazepines like Xanax with opioids like codeine due to the risk of overdose.
Can you overdose on Xanax and codeine?
It is possible to overdose on Xanax and codeine. The FDA has issued a Black Box Warning about taking benzodiazepines and opioids together for this reason.
Does the phrase “xans and lean” mean Xanax and Codeine?
Yes, the phrase refers to Xanax and a codeine-containing substance called lean. The “Xans” is Xanax, and lean is a mixture of codeine and soda.
Why do people mix Xanax and Codeine?
Some people mix Xanax and codeine to intensify the central nervous system depressant effects of each substance: this includes drowsiness and relaxation. Unfortunately, doing so can increase the risk of overdose and death.
Summing Up — The Risks of Xanax and Codeine Cough Syrup and Tablets
When drugs like Xanax and codeine are commonly prescribed, people can be lulled into a false sense of security. They may think just because it’s common to see people taking these medicines that they’re safe. Unfortunately, this is not the case.
Both Xanax and codeine cough syrup and tablets can be safe when taken exactly as prescribed and only over the short term. The risks are serious and often deadly otherwise. Mixing Xanax and codeine cough syrup or tablets can cause extreme impairment, sedation and a fatal overdose resulting from the depression of the central nervous system.
These dangerous interactions make it important to speak openly and honestly with your physician about any other substances you take before getting a new prescription. If you or a loved one are struggling with an addiction to alcohol or Xanax, treatment is available to enter recovery. Contact The Recovery Village to discuss treatment options that can address both substances and any co-occurring mental health needs.
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Drugs.com. “Codeine.” October 30, 2020. Accessed June 1, 2021.
Centers for Disease Control and Prevention. “Benzodiazepines and Opioids.” February 3, 2021. Accessed June 1, 2021.
Drug Enforcement Administration. “Controlled Substances.” May 10, 2021. Accessed June 1, 2021.
World Health Organization. “Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.” 2009. Accessed June 1, 2021.
Hallare, Jericho; Gerriets, Valerie. “Half Life.” StatPearls, October 6, 2020. Accessed June 1, 2021.
ClinCalc. “The Top 200 of 2021.” Accessed June 1, 2021.
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