Alprazolam

(al-prayz-uh-lam)

Trade/other name(s): Niravam, Xanax, Xanax SR

Why would this drug be used?

Alprazolam reduces anxiety and panic attacks and it is sometimes used with pain medicines to treat chronic cancer pain.

How does this drug work?

Alprazolam decreases seizures and anxiety and relaxes muscles by binding to receptors in the central nervous system. It belongs to a class of drugs called benzodiazepines. These drugs depress the central nervous system like alcohol, opioids and several other medicines. They slow down the brain and body, helping the patient feel calm and relaxed.

Before taking this medicine

Tell your doctor…

• If you are allergic to anything, including medicines, dyes, additives, or foods.
• If you have any conditions such as kidney disease or liver disease. These conditions may mean that your medicine dose, regimen, or timing need to be changed.
• If you have asthma, emphysema, bronchitis, sleep apnea, or other breathing problems. This medicine can worsen breathing.
• If you have glaucoma. People with acute narrow-angle glaucoma should not use this drug.
• If you are taking any medicine that makes you calmer or drowsy (sedative), or if you drink alcohol. The combination may produce serious side effects.
• If you have had a problem with alcohol or addiction in the past. This drug can be habit forming, and people with previous addictions are more at risk.
• If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. There may be an increased risk of harm to the fetus if a woman takes this drug during pregnancy. In addition, newborns whose mothers take the drug regularly in late pregnancy may have withdrawal symptoms after birth.
• If you are breast-feeding. The drug may pass into breast milk and affect the baby.
• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Alprazolam should not be taken with the anti-fungal drugs itraconazole or ketoconazole. They can cause alprazolam to build up to high levels in the blood and cause more serious side effects.

The following drugs can cause alprazolam to build up in the body, raising the risk of serious side effects. If you need one of these medicines while you are taking alprazolam, your doctor may be able to adjust your alprazolam dose:

• antidepressant drugs nefazodone (Serzone), fluvoxamine (Luvox), fluoxetine (Prozac, Serafem), imipramine (Tofranil), and desipramine (Norpramin)
• antibiotics erythromycin, clarithromycin, and similar drugs
• cimetidine (Tagamet)
• certain blood pressure medicines such as diltiazem and verapamil
• HIV drugs such as indinavir, ritonavir, and nelfinavir

Alprazolam can add to the effects of other medicines and substances that make you sleepy or less alert, such as:

• antihistamines
• tranquilizers (sedatives)
• sleeping pills
• muscle relaxers
• barbiturates
• anti-seizure medicines
• opioid pain medicines
• anesthetics
• antidepressants
• anti-psychotic drugs
• certain anti-nausea medicines
• alcohol

Using these kinds of substances while taking alprazolam can result in losing consciousness (passing out) and possibly death.

Certain medicines, supplements, and other substances can reduce the amount of alprazolam in the body, so that it does not work as well:

• anti-seizure medicines such as carbamazepine, phenobarbital, phenytoin
• pioglitazone (Actos), for diabetes
• St. John's wort
• TB medicines rifampin and rifabutin
• smoking cigarettes

Check with your doctor, nurse, or pharmacist about whether other medicines, vitamins, herbs, and supplements can cause problems with this medicine.

Interactions with foods

Grapefruit and grapefruit juice may cause this drug to build up in the body. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Alprazolam comes in several different forms, including pill, disintegrating pill, extended release pill, and liquid concentrate. All except the extended-release tablet are taken 3 to 4 times a day. Alprazolam can be taken with food or milk if it upsets your stomach.

The disintegrating pill begins to dissolve when it touches moisture. Be sure your hands are dry when you open the bottle. Get out the pill and place it on your tongue right away and allow it to dissolve in your mouth. It can also be swallowed whole with water.

The liquid concentrate must be carefully measured using the dropper that came with the medicine. It can be diluted in water or juice, or added to soft foods such as applesauce or pudding. If it is not eaten or drunk right away after being mixed with food or fluids, flush it down the toilet.

The extended-release tablet is usually taken once per day and must be swallowed whole. It should not be crushed, chewed, or broken, or you can get an overdose of the drug.

The doctor may start you at a lower dose and gradually increase if needed over 3 to 4 days. Once the right dose is found, the drug can be continued for up to 4 months. When stopping the drug, it is important to decrease the dose gradually, instead of just stopping it suddenly. Elderly patients may receive lower doses. Take this drug exactly as your doctor tells you to. If you do not understand the instructions, your doctor or nurse can explain them to you.

Store the medicine in a tightly closed container and away from children and pets.

Precautions

Alprazolam may cause you to feel drowsy or dizzy, especially at first. This is more likely if you are taking other drugs that depress the nervous system such as opioids, anti-anxiety drugs, muscle relaxers, or some anti-nausea medicines. Do not drive or operate heavy machinery until you know the effect the drug will have. Talk to your doctor or nurse if you feel too drowsy or have dizziness that does not go away.

Older people are more likely to be sleepy, dizzy, or to fall while taking alprazolam. Have a responsible adult with you for a few days after you start this medicine and any time you change doses.

If you are planning to have any kind of surgery, tell anyone involved, including dentists, that you are taking this medicine.

If you notice any strange or unusual thoughts or behavior while on this medicine, discuss it with your doctor. Rarely, people get confused, agitated, or start seeing or hearing things that are not there.

Call your doctor if you have seizures, confusion, shuffling walk, restlessness or tremor, fever, irregular heart rate, trouble urinating, yellow skin or eyes.

Rather than getting calmer, a few people respond to the drug in the opposite way, and become irritable, nervous, excited, anxious, and less sleepy. If this happens, call your doctor or nurse.

Rarely, allergic reactions happen with this medicine. Call your doctor if you notice skin welts, rash, trouble breathing or swallowing, or swelling in the mouth, face, or throat.

This is a controlled substance, and may be habit-forming. Take alprazolam only as directed by your doctor. Alprazolam may cause physical dependence (body goes into withdrawal if drug is suddenly stopped). Signs of physical dependence are common when the drug is taken for more than a few weeks. Physical dependence can be managed by stopping the medicine gradually over time. A few people also become psychologically dependent on alprazolam, which can lead to addiction. Some signs of psychological dependence are a strong desire to keep taking the medicine and wanting larger doses of the medicine. Talk with your doctor if you think this is happening to you.

Do not stop taking this drug without talking with your doctor. If you have been taking this drug for more than a few weeks, you may experience withdrawal symptoms for several days if you stop it suddenly. Most often this appears as irritability, nervousness, trouble sleeping, stomach cramps or upset stomach, trembling or shaking, and even hallucinations and seizures in those who have taken high doses for a long time. Talk with your doctor or nurse about stopping the drug by lowering the dose over time.

If you think that you or someone else may have taken an overdose of this medicine, get emergency help right away. Taking too much alprazolam, or taking it with alcohol or any other medicine that slows the nervous system can cause confusion, severe drowsiness or weakness, trouble walking or talking, coma, weak breathing, or even death.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

• drowsiness (mostly when first starting the drug)*
• dizziness, lightheadedness*
• tiredness (fatigue) (when first starting the drug)
• confusion (usually when first starting the drug)*
• headache (when first starting the drug)
• dry mouth
• decreased mental alertness*

Less common

• poor coordination*
• problems with thinking and memory
• nausea
• vomiting
• change in body weight

Rare

• vivid dreams
• bizarre behavior
• change in heart rate
• change in blood pressure*
• trouble urinating*
• palpitations
• swelling of feet
• rash*
• itching*
• hives*
• allergic reaction*
• withdrawal symptoms when the drug is stopped suddenly*
• change in sexual desire or ability
• paradoxical (opposite) effect in which you feel excited or "hyper" rather than calm*

*See "Precautions" section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved before 1984 (FDA cannot verify dates of drugs approved before 1984.)

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.