Xywav and Interactions: Other Drugs, Alcohol, and More
Xywav (calcium/magnesium/potassium/sodium oxybates) is a prescription drug that’s used to treat certain sleep disorders. Xywav can interact with alcohol and other medications, including zolpidem (Ambien, Edluar) and hydrocodone (Hysingla ER).
Xywav comes as an oral liquid solution. It’s used to treat the following sleep disorders:
An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.
Keep reading to learn about Xywav’s possible interactions. And for more information about Xywav, including details about its uses, see this article.
Boxed warnings
This drug has boxed warnings about the risks of central nervous system depression and misuse. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.
Risk of central nervous system (CNS) depression: Xywav carries a risk of CNS depression. This is because the drug works by slowing down the activity of your CNS.
The CNS includes the nerves, spinal cord, and brain. It manages many body functions, including movement, awareness, and thinking. CNS depression may lead to serious side effects. Examples include respiratory depression (slow or shallow breathing) and loss of consciousness. In severe cases, CNS depression can be fatal.
Doctors typically won’t prescribe Xywav with other medications that cause CNS depression. Examples include sedative hypnotics, opioids, and benzodiazepines. These interactions and others are described in more detail in the article below.
CNS depression can affect your ability to perform activities that require you to be alert, including driving. For this reason, you should avoid these activities for at least 6 hours after taking Xywav.
Risk of misuse: Xywav carries a risk of drug misuse. With misuse, a drug is taken in a way other than how a doctor prescribes it.
Misuse of Xywav can lead to serious side effects. Examples include respiratory depression, loss of consciousness, and seizures. In severe cases, the misuse of Xywav can be fatal.
Due to the risks of CNS depression and misuse, the drug is available only through the Xywav and Xyrem risk evaluation and mitigation strategy (REMS) program. The FDA requires REMS programs for certain drugs to help ensure they’re safely prescribed.
Does Xywav interact with other drugs?
Before you start taking Xywav, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Xywav interacts with herbs or vitamins and supplements, see the “Are there other interactions with Xywav?” section below.)
If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.
The table below lists drugs that may interact with Xywav. Keep in mind that this table does not include all drugs that may interact with Xywav. For more information about some of these interactions, see the “Drug interactions explained” section below.
| Drug group or drug name | Drug examples | What can happen |
|---|---|---|
| opioids | • fentanyl (Actiq, Fentora, others) • hydrocodone (Hysingla ER) • morphine (Mitigo, MS Contin, others) • oxycodone (Oxycontin, Xtampza ER, others) • tramadol (ConZip, Qdolo) | can increase the risk of central nervous system (CNS) depression |
| benzodiazepines | • alprazolam (Xanax, Xanax XR) • clonazepam (Klonopin) • diazepam (Valium, Valtoco, others) • lorazepam (Ativan, Loreev XR) • midazolam (Nayzilam, Seizalam) | can increase the risk of CNS depression |
| sedative hypnotics* | • eszopiclone (Lunesta) • zaleplon (Sonata) • zolpidem (Ambien, Edluar) | can increase the risk of CNS depression |
| muscle relaxers | • carisoprodol (Soma) • cyclobenzaprine (Amrix) • metaxalone • methocarbamol (Robaxin) • tizanidine (Zanaflex) | can increase the risk of CNS depression |
| certain antipsychotics | • clozapine (Clozaril, Versacloz) • perphenazine • thioridazine | can increase the risk of CNS depression |
| certain antidepressants | • doxepin (Silenor, Zonalon) • mirtazapine (Remeron) • trazodone | can increase the risk of CNS depression |
| certain seizure drugs | • carbamazepine (Carbatrol, Tegretol, others) • divalproex (Depakote, Depakote ER) • levetiracetam (Keppra, Spritam) | can increase the risk of side effects from Xywav and the seizure drug |
* To learn more about this interaction, see the “When should I avoid Xywav?” section below.
Note: Xywav has a boxed warning for the risk of CNS depression. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Boxed warnings” section at the top of this article.
When should I avoid Xywav?
Certain health conditions or other factors could raise your risk of harm if you take Xywav. In such cases, your doctor may not prescribe Xywav for you. These are known as contraindications. The list below includes contraindications of Xywav.
If you take sedative hypnotics or consume alcohol: If you take sedative hypnotics or might consume alcohol while taking Xywav, your doctor likely won’t prescribe Xywav for you.
Examples of sedative hypnotics include:
Sedative hypnotics, alcohol, and Xywav are CNS depressants. This means they slow down the activity of your nerves, spinal cord, and brain. Doctors typically won’t prescribe Xywav with other medications that cause CNS depression.
In fact, Xywav has a boxed warning about the risk of CNS depression. This is the most serious warning from the FDA. To learn more, see the “Boxed warnings” section at the top of this article.
If you take sedative hypnotics or consume alcohol, talk with your doctor before taking Xywav. They can recommend other treatment options that may be safer for you.
If you have succinic semialdehyde dehydrogenase deficiency: If you have a rare genetic (inherited) condition called succinic semialdehyde dehydrogenase deficiency, your doctor likely won’t prescribe Xywav for you. This is because the condition could prevent your body from breaking down Xywav properly. This may cause the level of Xywav to build up in your system, which raises your risk of side effects from the drug.
If you have succinic semialdehyde dehydrogenase deficiency, talk with your doctor before taking Xywav. They can recommend other treatment options that may be safer for you.
If you’ve had an allergic reaction: If you’ve had an allergic reaction to Xywav or any of its ingredients, your doctor likely won’t prescribe Xywav for you. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.
Before you start taking Xywav, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Xywav is safe for you to take.
Does Xywav interact with alcohol?
It’s not safe to drink alcohol during your Xywav treatment. Due to the risk of harm, your doctor is unlikely to prescribe the drug for you if you might drink alcohol while taking Xywav.
For details, see the “When should I avoid Xywav?” section above.
Learn more about certain drug interactions that can occur with Xywav.
Interaction with opioids
Xywav can interact with opioids, which are used to treat pain.
Examples of opioid medications include:
What could happen
Xywav and opioids can both cause CNS depression, so taking these drugs together can raise your risk of this side effect.
With CNS depression, the activity of your nerves, spinal cord, and brain is slowed. The CNS manages many body functions, including movement, awareness, and thinking.
CNS depression may lead to serious side effects or be fatal in severe cases. Examples of these side effects include respiratory depression (slow or shallow breathing) and loss of consciousness.
Keep in mind that Xywav has a boxed warning about the risk of CNS depression. This is the most serious warning from the FDA. To learn more, see the “Boxed warnings” section at the top of this article.
What you can do
Before starting Xywav, tell your doctor about any opioids you take. In most cases, they’ll avoid prescribing these medications together.
In some cases, such as after a procedure, you may need to take an opioid for short-term pain relief. In this case, your doctor may have you temporarily stop taking Xywav while you’re taking the opioid. Doing so will help reduce your risk of severe CNS depression.
If you have questions about taking Xywav with opioids, talk with your doctor or pharmacist.
Interaction with muscle relaxers
Xywav can interact with muscle relaxers, which are used to treat muscle spasms.
Examples of muscle relaxers include:
What could happen
Both Xywav and muscle relaxers can cause CNS depression. Taking these medications together can further increase your risk of this side effect.
You can learn more about Xywav’s risk of CNS depression in the “Boxed warnings” section at the top of this article.
What you can do
Before you start Xywav treatment, tell your doctor about any muscle relaxers you take. They’ll typically avoid prescribing these medications together.
In some cases, such as after an injury, you may need to take a muscle relaxer. If so, your doctor may temporarily stop your Xywav treatment while you’re taking the muscle relaxer. This will help lower your risk of severe CNS depression.
If you have questions about taking Xywav with muscle relaxers, talk with your doctor or pharmacist.
Interaction with certain seizure drugs
Xywav can interact with certain seizure drugs. Examples include:
What could happen
Taking Xywav with certain seizure drugs can increase your risk of side effects from either medication.
Specifically, taking Xywav with divalproex (Depakote, Depakote ER) may cause your body to break down Xywav more slowly than it should. This can raise the level of Xywav in your body, increasing your risk of side effects from the drug.
Other seizure drugs may raise your risk of CNS depression with Xywav. This is because both Xywav and certain seizure drugs may cause this side effect when taken alone. So taking these medications together can raise your risk of this side effect.
You can learn more about Xywav’s risk of CNS depression in the “Boxed warnings” section at the top of this article.
What you can do
Before starting Xywav, tell your doctor about any seizure medications you take. They can tell you whether it’s safe to take these drugs together.
If you take Xywav with divalproex, your doctor may prescribe a lower Xywav dosage for you. This helps reduce your risk of side effects from Xywav. You should not take a higher dose of either medication than your doctor prescribes.
If you have questions about taking Xywav with certain seizure drugs, talk with your doctor or pharmacist.
Are there other interactions with Xywav?
Xywav may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Xywav.
Does Xywav interact with supplements?
Before you start taking Xywav, talk with your doctor and pharmacist about any herbs or vitamins and supplements you take. Sharing this information with them may help you avoid possible interactions.
If you have questions about interactions that may affect you, talk with your doctor or pharmacist.
Xywav and herbs
There are currently no reports of Xywav interacting with herbs. But this doesn’t mean that interactions with herbs won’t be recognized in the future.
For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Xywav.
Xywav and vitamins
There are currently no reports of Xywav interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.
For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Xywav.
Does Xywav interact with food?
No specific foods have been reported to interact with Xywav.
However, it’s important to note that you should take Xywav at least 2 hours after eating. Taking Xywav with food could decrease the drug’s level in your body, making it less effective. To learn more about how to take Xywav, see this article.
Does Xywav interact with vaccines or lab tests?
There are currently no reports of Xywav interacting with vaccines or lab tests. If you have questions about receiving certain vaccines or having lab tests done during your Xywav treatment, talk with your doctor.
Does Xywav interact with cannabis or CBD?
Cannabis (commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been reported to interact with Xywav.
Xywav and cannabis products are central nervous system (CNS) depressants. This means they slow down the activity of your nerves, spinal cord, and brain. In rare cases, both drugs can cause serious side effects, including respiratory depression (slow or shallow breathing) and loss of consciousness. Combining Xywav and cannabis products raises this risk even further.
Xywav has a boxed warning about the risk of CNS depression. This is the most serious warning from the FDA. To learn more, see the “Boxed warnings” section at the top of this article.
Before you start treatment with Xywav, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
Does my health history affect whether I should take Xywav?
Certain medical conditions or other health factors may raise the risk of interactions with Xywav. Before taking Xywav, talk with your doctor about your health history. They’ll determine whether Xywav is right for you.
Health conditions or other factors that might interact with Xywav include:
Succinic semialdehyde dehydrogenase deficiency: If you have this rare genetic condition, your doctor likely won’t prescribe Xywav for you. This is because the condition could prevent your body from breaking down Xywav properly. This may cause the level of Xywav to build up in your system, which raises your risk of side effects from the drug.
Liver problems: Before taking Xywav, tell your doctor if you have a liver problem, such as liver failure. Your doctor may prescribe a lower Xywav dosage for you.
Breathing problems: Before starting Xywav treatment, tell your doctor if you have a breathing problem, such as sleep apnea. Xywav may cause respiratory depression. As a result, the drug may worsen any breathing problems you already have.
If you have breathing problems, your doctor can determine whether Xywav is a safe treatment option for you.
Mental health conditions: In rare cases, taking Xywav may lead to depression or suicidal thoughts and behaviors. This risk may be higher for people who’ve had suicidal thoughts or a mental health condition, such as depression or anxiety, before. Your doctor can determine whether Xywav is right for you.
Pregnancy: It’s not known whether Xywav is safe to take during pregnancy. If you’re pregnant or planning a pregnancy, talk with your doctor before taking Xywav.
Breastfeeding: It’s not known whether it’s safe to take Xywav while breastfeeding. The drug passes into breast milk, but it isn’t known whether the drug may cause side effects in a child who’s breastfed. If you’re breastfeeding or planning to do so, talk with your doctor about your options.
Allergic reaction: If you’ve had an allergic reaction to Xywav or any of its ingredients, your doctor will likely not prescribe Xywav. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.
Help is out there
If you or someone you know is in crisis and considering suicide or self-harm, please seek support:
If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.
If you are not in the same household, stay on the phone with them until help arrives.
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How can I prevent interactions?
Taking certain steps can help you avoid interactions with Xywav. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
It’s also important to understand Xywav’s label and other paperwork that may come with the drug. Colored stickers that describe interactions may be on the label. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. (If you did not get paperwork with Xywav, ask your pharmacist to print a copy for you.)
If you have trouble reading or understanding this information, your doctor or pharmacist can help.
Taking Xywav exactly as prescribed can also help prevent interactions.
What should I ask my doctor?
If you still have questions about Xywav and its possible interactions, talk with your doctor.
Questions you may want to ask your doctor include:
To learn more about Xywav, see these articles:
Thanks for the insightful post on Xywav interactions! It’s crucial to be aware of how other medications, alcohol, and even certain foods can impact Xywav. Understanding these interactions can help ensure both safety and efficacy. Looking forward to more detailed posts on managing sleep disorders.
This article on Xywav interactions is incredibly informative! It’s crucial to understand the potential effects of mixing medications and substances like alcohol. Thanks for shedding light on this topic. Safety first!
As someone who has been prescribed Xywav, I found this article extremely informative. It’s crucial to understand the potential interactions with other medications and substances like alcohol. Thank you for outlining the risks so clearly—it has made me more aware of the precautions I need to take while on this medication.
This post was incredibly informative! It’s so important to understand how Xywav interacts with other substances, especially given its specific uses and potential side effects. Thank you for breaking down the interactions with other drugs and alcohol so clearly. This is vital information for ensuring safety and avoiding adverse effects. Keep up the great work in spreading awareness!
Great article! Really informative and helpful for understanding how Xywav interacts with other substances. The breakdown of potential interactions with different drugs and alcohol is especially useful for those of us trying to manage multiple medications safely. Thanks for sharing this important information!
This post is incredibly informative! It’s so important to be aware of how medications like Xywav can interact with other substances, including alcohol and other drugs. Understanding these interactions can really help manage potential side effects and avoid any serious health complications. Thank you for sharing such crucial information!